gms | German Medical Science

Introduction: Disinvestment of low value practices could be an important step towards the improvement of health system’s efficiency.

Objectives: To pilot the usefulness of Clinical Practice Guidelines (CPGs) to identify possible candidates for disinvestment.

Material and methods: CPGs for chronic diseases developed in the Basque Country were identified. To pilot this strategy, the CPG on asthma management was selected. Recommendations which did not support the use of a technology were identified. Those recommendations with a possible impact on resource use were finally selected and classified as candidates for total or partial disinvestment. Different sources were explored to obtain data about their real use in our context.

Results: 12 of the 82 recommendations related to asthma were about practices that should not be continued to some extent. The implementation of 8 of them could have an impact on resource use (4 recommendations were referring to drugs, 3 to diagnostics and one to vaccines). Only 2 were identified as possible candidates for total disinvestment, but when looking to their current use, one of them was already not being prescribed. The other 6 recommendations were related to the appropriate use of the technology. Information about drug use was easy to find, but not for the rest of the technologies.

Discussion: Few candidates for total disinvestment can be identified from CPGs. The emphasis of “disinvestment” could be placed on better targeting. For this purpose, a process to study the usefulness of CPGs recommendations regarding the appropriate use of health technologies should be tested.