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  1. Article ; Online: Assessing the country-level involvement of nurses in COVID-19 vaccination campaigns: A qualitative study.

    Perlman, Saritte / Shamian, Judith / Catton, Howard / Ellen, Moriah

    International journal of nursing studies

    2023  Volume 146, Page(s) 104569

    Abstract: Background: As each country individually manages the COVID-19 pandemic, mass vaccination campaigns have varied considerably. Implementation campaigns often depend on nurses; however, nurses are not consistently involved in higher-level planning, ... ...

    Abstract Background: As each country individually manages the COVID-19 pandemic, mass vaccination campaigns have varied considerably. Implementation campaigns often depend on nurses; however, nurses are not consistently involved in higher-level planning, prioritization, and policy development decisions. This study aimed to examine the involvement and engagement of nurses in country-level COVID-19 mass vaccination policies and practices in 10 Office of Economic Cooperation and Development countries, identify barriers and factors to enhancing the engagement of nurses in the evidence-informed mass vaccination decision-making processes, and suggest areas for improvement.
    Methods: A qualitative study using in-depth semi-structured interviews was conducted as a follow-up study to an International Council of Nurses survey. The study sample included a purposeful sample of 14 country-representative nurses from 10 Office of Economic Cooperation and Development countries. Interview questions focused on each country's overall COVID-19 vaccination campaign and policies, participants' perspectives regarding the involvement of nurses in the planning, design, and implementation of the mass vaccination program observed outcomes, and the impact of nursing on the outcomes. Interviews were recorded, transcribed, translated where necessary, coded, and thematically analyzed.
    Results: Main areas of involvement identified by participants were membership in advising and decision-making committees, operationalization planning, implementation and coordination processes, education efforts, and nurses' interactions with the media. Seven themes emerged among perceived facilitators of nursing involvement: existing systems and infrastructure, nursing profession-related skills and competencies, communication and messaging, multidisciplinary and interagency work, recognition and visibility of nurses and nursing, trust in nurses, and nursing pride. Meanwhile, perceived barriers included lack of a voice, recognition and appreciation for nursing, workforce-related challenges, decentralization of responsibility and authority, supply and access issues, downstream effects of the pandemic, and non-COVID-related nursing barriers. Three main themes emerged among suggestions made by participants for improved involvement of nursing: culture change within nursing and healthcare, opportunities and momentum to build upon, and perceptions of responsible parties.
    Conclusions: Nurses play a central role in providing health services but are inconsistently included in the policy, planning, and decision-making processes. Findings highlighted the critical importance of nursing leadership roles and expanded roles for nurses. Nursing should be represented by high-level leaders as part of multidisciplinary decision-making groups, educational initiatives for involvement in health policy should be implemented in nursing schools and continuing education, and advocacy and inclusion efforts should utilize bottom-up and top-down approaches concurrently.
    MeSH term(s) Humans ; COVID-19 Vaccines ; Follow-Up Studies ; Pandemics ; COVID-19/prevention & control ; Nurse's Role ; Qualitative Research ; Immunization Programs ; Nurses
    Chemical Substances COVID-19 Vaccines
    Language English
    Publishing date 2023-07-28
    Publishing country England
    Document type Journal Article
    ZDB-ID 80148-3
    ISSN 1873-491X ; 0020-7489
    ISSN (online) 1873-491X
    ISSN 0020-7489
    DOI 10.1016/j.ijnurstu.2023.104569
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    Zs.B 130: Show issues Location:
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    ab Jg. 2022: Lesesaal (EG)

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  2. Article ; Online: Review of Israel's action and response during the COVID-19 pandemic and tabletop exercise for the evaluation of readiness and resilience-lessons learned 2020-2021.

    Muhsen, Khitam / Cohen, Dani / Glatman-Freedman, Aharona / Husseini, Sari / Perlman, Saritte / McNeil, Carrie

    Frontiers in public health

    2024  Volume 11, Page(s) 1308267

    Abstract: Background: Reevaluating response plans is essential to ensuring consistent readiness and resilience to the COVID-19 pandemic. The "During Action Review" and Tabletop (DART) methodology provides a retrospective and prospective assessment to inform the ... ...

    Abstract Background: Reevaluating response plans is essential to ensuring consistent readiness and resilience to the COVID-19 pandemic. The "During Action Review" and Tabletop (DART) methodology provides a retrospective and prospective assessment to inform the adaptive response. Israel introduced COVID-19 vaccinations in December 2020 and was the first country to implement booster vaccination to address waning immunity and surges caused by new variants. We assessed Israel's readiness and resilience related to COVID-19 response while capturing the pre-vaccination and vaccination periods.
    Methods: A DART analysis was conducted between December 2020 and August 2021 among experts involved in the management of the COVID-19 pandemic in Israel. During the retrospective stage, a role-based questionnaire and discussions were undertaken in a participant-led review of the response, focusing on epidemiology and surveillance, risk communication, and vaccines. The prospective stage included tabletop exercises to evaluate short to long-term simulated scenarios.
    Results: Participants emphasized the pivotal role of Israel globally by sharing experiences with the pandemic, and vaccination. Perceived strengths included multi-sectoral collaboration between the Ministry of Health, healthcare providers, academia, military, and others, stretching capacities, expanding laboratory workload, and establishing/maintaining surveillance. The vaccine prioritization plan and strong infrastructure, including computerized databases, enabled real-life assessment of vaccine uptake and impact. Challenges included the need to change case definitions early on and insufficient staffing. Quarantine of patients and contacts was particularly challenging among underprivileged communities. Risk communication approaches need to focus more on creating norms in behavior. Trust issues and limited cooperation were noted, especially among ethnic and religious minorities. To ensure readiness and resiliency, participants recommended establishing a nationally deployed system for bringing in and acting upon feedback from the field, especially concerning risk communication and vaccines.
    Conclusion: Our study appraised strengths and weaknesses of the COVID-19 pandemic response in Israel and led to concrete recommendations for adjusting responses and future similar events. An efficient response comprised multi-sectoral collaboration, policy design, infrastructure, care delivery, and mitigation measures, including vaccines, while risk communication, trust issues, and limited cooperation with minority groups were perceived as areas for action and intervention.
    MeSH term(s) Humans ; COVID-19/epidemiology ; COVID-19/prevention & control ; Israel/epidemiology ; Pandemics/prevention & control ; Prospective Studies ; Resilience, Psychological ; Retrospective Studies ; Vaccines
    Chemical Substances Vaccines
    Language English
    Publishing date 2024-01-24
    Publishing country Switzerland
    Document type Journal Article ; Review ; Research Support, Non-U.S. Gov't
    ZDB-ID 2711781-9
    ISSN 2296-2565 ; 2296-2565
    ISSN (online) 2296-2565
    ISSN 2296-2565
    DOI 10.3389/fpubh.2023.1308267
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  3. Article ; Online: A new metabolic syndrome prediction model for self-evaluation as a primary screening tool in an apparently MetS-free population.

    Sherman-Hahn, Sabrina / Izkhakov, Elena / Perlman, Saritte / Ziv-Baran, Tomer

    Preventive medicine

    2023  Volume 175, Page(s) 107701

    Abstract: Background: Metabolic syndrome (MetS) is a growing global public health concern associated with increased morbidity and mortality. The study aimed to establish a simple self-evaluated prediction model to identify MetS.: Methods: A cross-sectional ... ...

    Abstract Background: Metabolic syndrome (MetS) is a growing global public health concern associated with increased morbidity and mortality. The study aimed to establish a simple self-evaluated prediction model to identify MetS.
    Methods: A cross-sectional study based on the American National Health and Nutrition Examination Survey database was performed. Participants aged ≥20 in the 2009-2018 surveys, with no current pregnancy or major morbidities, were included. The model was built with data from 2009 to 2016 and validated using 2017-2018 data. MetS was defined according to AHA/NHLBI guidelines. Multivariable logistic regression was applied to build a prediction model. The area under the receiver operating characteristic curve (AUC) was used to assess the discrimination ability and the maximal Youden's index was used to identify the optimal cut-off value.
    Results: The study included 4245 individuals (median age 37, IQR 28-49, 51.8% females) in the training group and 911 individuals (median age 37, IQR 28-52, 52.5% females) in the validation group. Older age, male gender, non-Black race, no postsecondary education, and higher BMI were significantly associated with increased risk of MetS. The final model included age, gender, race, education, and BMI, and showed good discrimination ability (AUC = 0.810, 95% CI 0.793-0.827, sensitivity 80.4%, specificity 66.2%, positive likelihood ratio 2.379, negative likelihood ratio 0.296, PPV 59.6% and NPV 84.5%).
    Conclusion: A new model for self-evaluation may serve as a primary, easy-to-use screening tool to identify MetS in an apparently MetS-free population. A simple application may serve for primary and secondary prevention, thus enabling risk reduction in the development of cardiovascular morbidity and health expenditure.
    Language English
    Publishing date 2023-09-12
    Publishing country United States
    Document type Journal Article
    ZDB-ID 184600-0
    ISSN 1096-0260 ; 0091-7435
    ISSN (online) 1096-0260
    ISSN 0091-7435
    DOI 10.1016/j.ypmed.2023.107701
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    Zs.A 878: Show issues Location:
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    bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular
    Jg. 1995 - 2021: Lesesall (1.OG)
    ab Jg. 2022: Lesesaal (EG)

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  4. Article ; Online: Evaluation of Montreal Cognitive Assessment (MoCA) Administered via Videoconference.

    Zadik, Limor / Perlman, Saritte / Barak, Orly / Ziv-Baran, Tomer

    Journal of the American Medical Directors Association

    2023  Volume 24, Issue 12, Page(s) 1942–1947.e3

    Abstract: Objectives: Telemedicine provides much potential for promoting health care. The Montreal Cognitive Assessment (MoCA) is a screening tool for identifying mild cognitive impairment. This study aims to evaluate the agreement between MoCA assessed face-to- ... ...

    Abstract Objectives: Telemedicine provides much potential for promoting health care. The Montreal Cognitive Assessment (MoCA) is a screening tool for identifying mild cognitive impairment. This study aims to evaluate the agreement between MoCA assessed face-to-face vs via videoconference using a mobile phone.
    Design: A randomized crossover study.
    Setting and participants: A randomly selected sample of patients admitted to the geriatric rehabilitation department in a large tertiary medical center in 2021-2022.
    Methods: The MoCA was conducted twice for each patient, with a 10- to 20-day interval between assessments. To avoid a learning effect, alternate MoCA versions were used for each patient. Intraclass correlation coefficient (ICC), kappa, weighted kappa, and the Bland-Altman plot were used to evaluate the agreement between administration methods. To identify variables associated with low agreement, data on participant characteristics, order of administration methods, and test versions were collected, and univariate and multivariable analyses were performed.
    Results: Forty-four patients were included in the study. The median age was 83 years [interquartile range (IQR 76-87)] and 75% were females. Median overall MoCA score was 24 points (IQR 21-26) when administered face-to-face, and 23.5 points (IQR 21-26) via videoconference. Excellent agreement (ICC = 0.89) was observed in the total MoCA score. Moderate-substantial agreement was observed in subsection scores (kappa 0.436-0.686), except for the language subsection where fair agreement was observed (kappa 0.331). Anxiety was assessed by Hospital Anxiety and Depression Scale and associated with lower agreement (ICC = 0.76 in patients with anxiety vs ICC = 0.92 in patients without anxiety). None of the other studied variables were associated with a difference between administration methods.
    Conclusions and implications: Conducting a MoCA via videoconference using a mobile phone is another method of providing medical care to people without significant visual or hearing impairment that restricts their use of a mobile phone, during routine times and in emergencies where social distancing is needed.
    MeSH term(s) Female ; Humans ; Aged ; Aged, 80 and over ; Male ; Cross-Over Studies ; Cognitive Dysfunction/diagnosis ; Mental Status and Dementia Tests ; Hospitalization ; Videoconferencing ; Neuropsychological Tests
    Language English
    Publishing date 2023-09-12
    Publishing country United States
    Document type Randomized Controlled Trial ; Journal Article
    ZDB-ID 2171030-2
    ISSN 1538-9375 ; 1525-8610
    ISSN (online) 1538-9375
    ISSN 1525-8610
    DOI 10.1016/j.jamda.2023.08.015
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    Zs.A 5971: Show issues Location:
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    Jg. 1995 - 2021: Lesesall (2.OG)
    ab Jg. 2022: Lesesaal (EG)

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  5. Article ; Online: Fast vs. Regular Track for Lung and Pancreatic Cancer Diagnosis-Time from Initial Finding to Final Diagnosis and Patient Survival.

    Rak, Orit / Urban, Damien / Perlman, Saritte / Ziv-Baran, Tomer / Katorza, Eldad

    Journal of medical systems

    2023  Volume 47, Issue 1, Page(s) 48

    Abstract: Background: Health systems around the world have begun implementing unique tracks to expedite diagnosis and improve survival of patients with suspected cancers. This study aimed to compare characteristics and survival between patients diagnosed by way ... ...

    Abstract Background: Health systems around the world have begun implementing unique tracks to expedite diagnosis and improve survival of patients with suspected cancers. This study aimed to compare characteristics and survival between patients diagnosed by way of fast and regular diagnostic tracks.
    Methods: A historical cohort study of patients (age ≥ 18) diagnosed with lung or pancreatic cancers between 09/2017 and 03/2020 on a fast diagnostic track and treated in a tertiary hospital versus a random sample of patients with the same cancer types who began treatment in the hospital over the same period of time after being diagnosed utilizing the regular track in the community.
    Results: The study included 336 patients (108 fast-track diagnostics, 228 regular track diagnostics). Advanced stages III-IV at diagnosis were more likely in the fast-track group (94.4% vs. 81.1%, p = 0.001). The median time from initial cancer suspicion to diagnosis was 21 days (IQR 14-37) for the fast-track vs. 31 days (IQR 18-51) for the regular track (p < 0.001). During the follow-up period, 56 patients from the fast-track and 131 patients from the regular track died. No significant difference was found in the median survival time between the fast and regular tracks, whether from the onset of symptoms, diagnosis, or treatment initiation.
    Conclusion: Patients referred to the fast-track were more likely to be diagnosed at a further advanced stage of their cancer. The fast-track shortened the time until diagnosis and treatment but no difference was found in median survival between the tracks, perhaps due to late referral and high fatality rates.
    MeSH term(s) Humans ; Cohort Studies ; Pancreatic Neoplasms/diagnosis ; Referral and Consultation ; Lung ; Pancreatic Neoplasms
    Language English
    Publishing date 2023-04-15
    Publishing country United States
    Document type Journal Article
    ZDB-ID 423488-1
    ISSN 1573-689X ; 0148-5598
    ISSN (online) 1573-689X
    ISSN 0148-5598
    DOI 10.1007/s10916-023-01939-y
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    Zs.A 1426: Show issues Location:
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  6. Article ; Online: Nurses' Perceptions on the Overuse of Health Services: A Qualitative Study.

    Ellen, Moriah E / Perlman, Saritte

    Journal of nursing scholarship : an official publication of Sigma Theta Tau International Honor Society of Nursing

    2018  Volume 50, Issue 2, Page(s) 219–227

    Abstract: Purpose: To examine whether nurses in Israel think there is overuse of health services, the reasons behind the issue, and ways to reduce the overuse.: Design: This was a qualitative study using semistructured interviews. A convenience sample of ... ...

    Abstract Purpose: To examine whether nurses in Israel think there is overuse of health services, the reasons behind the issue, and ways to reduce the overuse.
    Design: This was a qualitative study using semistructured interviews. A convenience sample of community care nurses from health clinics across Israel was interviewed. Interviews focused on common areas of overuse, outcomes of overuse, causes of overuse, and potential ways to address the issue. Interviews were recorded, transcribed, and analyzed thematically.
    Findings: Overuse of antibiotics, imaging, blood tests, and prenatal surveillance were cited as main areas of health service overuse. Participants stated that negative outcomes of overuse could be seen at patient, health system, and population levels. Factors influencing overuse included patient satisfaction, physician fears, and insecurities. Potential interventions included improving physicians' diagnostic confidence, increasing appointment times, providing patients with more treatment information, and implementing a unified computerized system across medical institutions.
    Conclusions: Nurses mentioned physicians and patients as main actors in influencing overuse; hence, those populations should be researched further. The health system was identified as the responsible party to address the issue. Health system leaders must consider potential barriers, and investigate interventions that match current culture and context within the health system.
    Clinical relevance: Nurses can play an essential role in limiting overuse and mitigating subsequent harms to patients.
    MeSH term(s) Adult ; Aged ; Anti-Bacterial Agents/therapeutic use ; Attitude of Health Personnel ; Female ; Health Services Research ; Humans ; Israel ; Medical Overuse ; Middle Aged ; Nurses ; Patient Satisfaction ; Pregnancy ; Prenatal Care/organization & administration ; Qualitative Research ; Women's Health
    Chemical Substances Anti-Bacterial Agents
    Language English
    Publishing date 2018-01-11
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2008214-9
    ISSN 1547-5069 ; 1527-6546
    ISSN (online) 1547-5069
    ISSN 1527-6546
    DOI 10.1111/jnu.12371
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    Zs.B 2842: Show issues Location:
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  7. Article ; Online: Too Much Cancer Care?: Nurses' Perspectives on the Unnecessary Use of Oncology Services.

    Ellen, Moriah E / Perlman, Saritte / Shach, Ruth

    Cancer nursing

    2020  Volume 44, Issue 4, Page(s) E236–E243

    Abstract: Background: "Unnecessary use of health services" refers to care that does not add value for patients and can lead to physical, emotional, and economical harm. High rates of overuse have been reported within oncology, and patients experience its ... ...

    Abstract Background: "Unnecessary use of health services" refers to care that does not add value for patients and can lead to physical, emotional, and economical harm. High rates of overuse have been reported within oncology, and patients experience its consequences.
    Objective: The aim of this study was to explore perceptions and experiences of oncology nurses regarding unnecessary use of oncology services.
    Methods: In-depth, semistructured interviews were conducted with a convenience sample of 20 oncology nurses currently practicing in Israel. Interviews were recorded, transcribed, and analyzed thematically.
    Results: Themes included perceptions of unnecessary use of health services in cancer (causes and effects of unnecessary use, current and proposed solutions) and negative effects of unnecessary cancer care on patients, families, providers, and the system, including decreased quality of life, increased suffering, and emotional effects on patients and families. Causes were seen on provider, family, and patient levels, such as difficulty for providers to "give up," lack of registered nurses' authority, and family and patient demands. Multidisciplinary care provision, nurses' role, and the patient-provider relationship were seen as existing facilitators minimizing unnecessary use. Future improvement can be achieved by strengthening relationships, providing support to healthcare providers, and improving communication.
    Conclusions: Nurses perceive unnecessary use of health services as a result of multiple, interlinked and complex causes, but few targeted interventions exist. Future research should explore quantifying unnecessary use to determine an accurate representation of the issue.
    Implications for practice: Solutions should include engaging patients and families, involving nurses, and fostering multidisciplinary collaborative teamwork to positively affect care and treatment decision-making processes.
    MeSH term(s) Adult ; Female ; Humans ; Israel ; Male ; Medical Overuse/statistics & numerical data ; Middle Aged ; Neoplasms/therapy ; Nurse's Role ; Nurses/statistics & numerical data ; Palliative Care/statistics & numerical data ; Quality of Life/psychology
    Language English
    Publishing date 2020-03-25
    Publishing country United States
    Document type Journal Article
    ZDB-ID 391995-x
    ISSN 1538-9804 ; 0162-220X
    ISSN (online) 1538-9804
    ISSN 0162-220X
    DOI 10.1097/NCC.0000000000000814
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    Zs.A 1538: Show issues Location:
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  8. Article ; Online: Determinants of Direct Costs of HIV-1 Outpatient Care in Israel.

    Rom, Tom / Levy, Itzchak / Perlman, Saritte / Ziv-Baran, Tomer / Mor, Orna

    International journal of environmental research and public health

    2022  Volume 19, Issue 21

    Abstract: HIV-1 patients place an economic burden on the health system. The objectives of this study were to estimate the direct HIV-1 costs and cost-related factors of HIV-1 patients in Israel and identify cost predictors. We conducted a retrospective study of ... ...

    Abstract HIV-1 patients place an economic burden on the health system. The objectives of this study were to estimate the direct HIV-1 costs and cost-related factors of HIV-1 patients in Israel and identify cost predictors. We conducted a retrospective study of randomly selected HIV-1 patients aged ≥18 who visited a large outpatient clinic in 2015 and/or 2019. Yearly costs of physician and nurse visits, antiretroviral therapy (ART) and laboratory tests were calculated in USD using the 2020 purchasing power parities. Associations between disease characteristics and costs were analyzed using univariate and multivariable analysis. The median (IQR) total direct costs per patient per year were USD 12,387 (9813-14,124) and USD 12,835 (11,651-13,970) in 2015 (
    MeSH term(s) Humans ; Female ; Male ; HIV-1 ; Retrospective Studies ; Health Care Costs ; Israel/epidemiology ; HIV Infections/drug therapy ; HIV Infections/epidemiology ; HIV Seropositivity ; Ambulatory Care
    Language English
    Publishing date 2022-11-05
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2175195-X
    ISSN 1660-4601 ; 1661-7827
    ISSN (online) 1660-4601
    ISSN 1661-7827
    DOI 10.3390/ijerph192114542
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  9. Article ; Online: Exploring community healthcare providers' perceptions on antimicrobial resistance.

    Ellen, Moriah E / Shach, Ruth / Perlman, Saritte

    Journal of global antimicrobial resistance

    2019  Volume 18, Page(s) 215–222

    Abstract: Objectives: Antimicrobial resistance (AMR) is a threat to global health, making previously curable diseases disabling or incurable. Human misuse of antimicrobials exacerbates the issue. As stewards to the public and prescribers of antimicrobials, ... ...

    Abstract Objectives: Antimicrobial resistance (AMR) is a threat to global health, making previously curable diseases disabling or incurable. Human misuse of antimicrobials exacerbates the issue. As stewards to the public and prescribers of antimicrobials, healthcare providers are vital to reducing AMR, thus their perceptions and experiences around the issue must be explored. This study aimed to understand the perceptions of community nurses and physicians regarding the causes of AMR as well as barriers and facilitators to addressing it.
    Methods: In-depth, semi-structured interviews were conducted to understand the perceptions of nurses and physicians on these issues.
    Results: Overall, participants expressed that both environmental and human causes at various levels contribute to AMR. Whilst most themes were discussed by both healthcare practitioner groups, nurses more frequently mentioned patient causes and patient education compared with physicians. Participants also reflected on facilitators to reduce AMR, including guidelines, patient and provider education, and top-down and bottom-up initiatives. Identified barriers included patient demands, physician pressures and fears, and systemic overworking of physicians.
    Conclusion: This study demonstrated numerous factors underpinning AMR and many barriers to addressing it, hence a multifaceted approach is required. This work also offers insight on how different groups can be utilised or will react to interventions.
    MeSH term(s) Adult ; Aged ; Anti-Bacterial Agents/therapeutic use ; Attitude of Health Personnel ; Community Health Services ; Drug Resistance, Bacterial ; Female ; Health Knowledge, Attitudes, Practice ; Health Personnel ; Humans ; Male ; Middle Aged ; Nurses ; Physicians ; Surveys and Questionnaires
    Chemical Substances Anti-Bacterial Agents
    Language English
    Publishing date 2019-02-20
    Publishing country Netherlands
    Document type Journal Article
    ZDB-ID 2710046-7
    ISSN 2213-7173 ; 2213-7165
    ISSN (online) 2213-7173
    ISSN 2213-7165
    DOI 10.1016/j.jgar.2019.02.010
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  10. Article ; Online: Understanding Physicians' Perceptions of Overuse of Health Services in Oncology.

    Ellen, Moriah / Perlman, Saritte / Horowitz, Einav / Shach, Ruth / Catane, Raphael

    Medical care research and review : MCRR

    2020  Volume 78, Issue 5, Page(s) 511–520

    Abstract: Overuse rates in oncology are high, but areas of possible improvement exist for reducing it and improving quality of care. This study explores perceptions and experiences of oncologists in Israel regarding overuse of health services within oncology. In- ... ...

    Abstract Overuse rates in oncology are high, but areas of possible improvement exist for reducing it and improving quality of care. This study explores perceptions and experiences of oncologists in Israel regarding overuse of health services within oncology. In-depth, semistructured interviews were conducted focusing on causes of overuse, facilitators for reduction, and suggestions for improvement. Interviews were audio recorded, transcribed, coded, and thematically analyzed. Physicians reported patient-level causes including "well-informed" and "demanding" patients; physician-level causes including desire to satisfy patients, lack of confidence, time, and skills; and system-level causes like ease of access, and lack of alignment and coordination. Physicians can reduce overuse through patient dialogue, building trust and solidifying patient-physician relationships, and further reduce overuse with better teamwork. Improvements can be made through educational initiatives, and bottom-up solutions. Policy makers and decision makers should develop appropriate interventions addressing health service overuse, including improving patient education and instilling confidence and knowledge in physicians.
    MeSH term(s) Health Services ; Humans ; Medical Overuse ; Perception ; Physicians ; Qualitative Research
    Language English
    Publishing date 2020-04-23
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 1232314-7
    ISSN 1552-6801 ; 1077-5587
    ISSN (online) 1552-6801
    ISSN 1077-5587
    DOI 10.1177/1077558720915112
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