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      Epidemiological study on gender bias and low-value practices in primary care: a study protocol

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          Abstract

          Introduction

          Evidence shows that gender has a substantial impact on health behaviours, access to and use of health systems and health system responses. This study aims to assess gender bias in patients subjected to low-value practices in the primary care setting and to develop recommendations for reducing adverse events that women experience for this reason.

          Methods and analysis

          A Delphi study will be performed to reach a consensus on the ‘Do Not Do’ recommendations with a possible gender bias. A retrospective cohort study in a random selection of medical records will then be carried out to identify the frequency of adverse events that occur when the selected ‘Do Not Do’ recommendations are ignored. Qualitative research techniques (consensus conference and nominal group) will be carried out to develop recommendations to address any gender bias detected, considering barriers and facilitators in clinical practice.

          Ethics and dissemination

          The study was approved by the ethics committee of San Juan de Alicante Hospital (San Juan de Alicante, Spain) Reference N. 21/061. We will disseminate the research findings via peer-reviewed articles, presentations at national and international scientific forums and webinars.

          Trial registration number

          The study was registered at ClinicalTrials.gov (NCT05233852) on 10 February 2022.

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          Most cited references32

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          Waste in the US Health Care System

          The United States spends more on health care than any other country, with costs approaching 18% of the gross domestic product (GDP). Prior studies estimated that approximately 30% of health care spending may be considered waste. Despite efforts to reduce overtreatment, improve care, and address overpayment, it is likely that substantial waste in US health care spending remains.
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            Evidence for overuse of medical services around the world.

            Overuse, which is defined as the provision of medical services that are more likely to cause harm than good, is a pervasive problem. Direct measurement of overuse through documentation of delivery of inappropriate services is challenging given the difficulty of defining appropriate care for patients with individual preferences and needs; overuse can also be measured indirectly through examination of unwarranted geographical variations in prevalence of procedures and care intensity. Despite the challenges, the high prevalence of overuse is well documented in high-income countries across a wide range of services and is increasingly recognised in low-income countries. Overuse of unneeded services can harm patients physically and psychologically, and can harm health systems by wasting resources and deflecting investments in both public health and social spending, which is known to contribute to health. Although harms from overuse have not been well quantified and trends have not been well described, overuse is likely to be increasing worldwide.
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              Eliminating waste in US health care.

              The need is urgent to bring US health care costs into a sustainable range for both public and private payers. Commonly, programs to contain costs use cuts, such as reductions in payment levels, benefit structures, and eligibility. A less harmful strategy would reduce waste, not value-added care. The opportunity is immense. In just 6 categories of waste--overtreatment, failures of care coordination, failures in execution of care processes, administrative complexity, pricing failures, and fraud and abuse--the sum of the lowest available estimates exceeds 20% of total health care expenditures. The actual total may be far greater. The savings potentially achievable from systematic, comprehensive, and cooperative pursuit of even a fractional reduction in waste are far higher than from more direct and blunter cuts in care and coverage. The potential economic dislocations, however, are severe and require mitigation through careful transition strategies.
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                Author and article information

                Journal
                BMJ Open
                BMJ Open
                bmjopen
                bmjopen
                BMJ Open
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                2044-6055
                2023
                9 May 2023
                : 13
                : 5
                : e070311
                Affiliations
                [1 ]departmentDepartment of Health Psychology , Ringgold_16753Miguel Hernandez University of Elche , Elche, Spain
                [2 ]departmentDepartment of Clinical Medicine , Ringgold_16753Miguel Hernandez University of Elche , San Juan de Alicante, Spain
                [3 ]departmentAtenea Research Group , Foundation for the Promotion of Health and Biomedical Research , San Juan de Alicante, Spain
                [4 ]Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS) , San Juan de Alicante, Spain
                [5 ]Ringgold_117368Centro de Investigacion Biomedica en Red de Epidemiologia y Salud Publica , Madrid, Spain
                [6 ]departmentDepartment of Public Health , Miguel Hernandez University of Elche , San Juan de Alicante, Spain
                [7 ]Totana Sur Primary Health Center , Murcia, Spain
                [8 ]Grupo de investigación IIS-Aragón H36_23D Feminización, Ética y Profesionalidad de las ciencias de la salud (FEPS) , Tarragona, Spain
                [9 ]departmentTerritorial Quality Unit. Management of Camp de Tarragona , Catalan Health Institute , Tarragona, Spain
                [10 ]departmentHealth & Wellbeing , Ringgold_4414LAB University of Applied Sciences—Lappeenrannan kampus , Lappeenranta, Finland
                [11 ]departmentFaculty of Health Sciences , Ringgold_205537University of Eastern Finland , Kuopio, Finland
                [12 ]Alicante-Sant Joan d'Alacant Health Department , San Juan de Alicante, Spain
                Author notes
                [Correspondence to ] Dr Virtudes Pérez-Jover; v.perez@ 123456umh.es

                IC and AL-P are joint first authors.

                CC-M and JJM are joint senior authors.

                Author information
                http://orcid.org/0000-0002-6981-7284
                http://orcid.org/0000-0002-2117-0178
                http://orcid.org/0000-0001-9089-0497
                http://orcid.org/0000-0002-0706-9911
                http://orcid.org/0000-0002-8630-7251
                http://orcid.org/0000-0002-9391-9192
                http://orcid.org/0000-0002-9091-7255
                http://orcid.org/0000-0002-3192-7672
                http://orcid.org/0000-0001-6497-083X
                Article
                bmjopen-2022-070311
                10.1136/bmjopen-2022-070311
                10174026
                37160394
                64c55b61-e071-4dbe-92fe-922c4b66daf7
                © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

                This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:  http://creativecommons.org/licenses/by-nc/4.0/.

                History
                : 18 November 2022
                : 21 April 2023
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100003359, Generalitat Valenciana;
                Award ID: Prometeu 2021/061
                Categories
                General practice / Family practice
                1506
                1696
                Protocol
                Custom metadata
                unlocked

                Medicine
                primary care,quality in health care,health & safety
                Medicine
                primary care, quality in health care, health & safety

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