Interventions to Reduce Overuse of Coronary Artery Disease Cares: A Systematic Review

Coronary artery disease is the leading cause of death and disability around the world and care of this disease is at risk of overuse. The present study objective is to identify articles that have provided tested interventions to reduce the overuse of services in coronary artery cares. In this systematic review, the search method included all elements of the PRISMA checklist for systematic review. PubMed and Web of Science databases were used in this regard. After searching, two researchers reviewed the titles and then the abstracts of the articles and excluded the non-relevant articles based on the previously-defined inclusion and exclusion criteria. Some articles were also added through manual searching of the reference articles. After ranking the articles, the most relevant articles were selected. Initially, 530 articles were selected and by considering the inclusion and exclusion criteria, 12 articles were selected based on their authenticity, methodology quality, and number of the individuals who were potentially affected. These articles had provided tested interventions to reduce the overuse of coronary artery cares. The strategies found in this study included the dissemination of appropriate use criteria and training based on them and their inclusion in decision support tools. Also, using prior probability and risk classification of patients, feedback for unnecessary cases, lack of repayment for unnecessary cases, using less invasive measures as gatekeepers for more invasive measures, using certificate of need rules, giving information for patients and informing them on the benefits and risks of interventions, giving decision aid tools to patients. Anyway To design strategies to reduce unnecessary services, both the patient and the physician role in providing unnecessary services should be considered and interventions must be designed to influence their beliefs and attitudes toward the benefits and risks of diagnostic and therapeutic interventions and make better decisions, and eventually, adopt appropriate behaviors by encouraging and punishing them.