We conducted a critical interpretive synthesis informed by a stakeholder-engagement process. The synthesis identified relevant empirical and non-empirical articles about system-level overuse.

Health systems are increasingly focusing on the issue of ‘overuse’ of health services and how to address it. the researchers developed a framework focused on

(1) The rationale and context for health systems prioritizing addressing overuse,

(2) Elements of a comprehensive process and approach to reducing overuse and

(3) Implementation considerations for addressing overuse.

Methods

The researchers conducted a critical interpretive synthesis informed by a stakeholder-engagement process. The synthesis identified relevant empirical and non-empirical articles about system-level overuse.

Two reviewers independently screened records, assessed for inclusion and conceptually mapped included articles. From these, they selected a purposive sample, created structured summaries of key findings and thematically synthesized the results.

Results

The search identified 3545 references, from which they included 251. Most articles (76%;n = 192) were published within five years of conducting the review and addressed processes for addressing overuse (63%; n = 158) or political and health system context (60%; n = 151).

Besides negative outcomes at the patient, system and global level, there were various contextual factors to addressing service overuse that seem to be key issue drivers.

Processes for addressing overuse can be grouped into three elements comprising a comprehensive approach, including

(1) Approaches to identify overused health services,

(2) Stakeholder– or patient-led approaches and

(3) Government-led initiatives. Key implementation considerations include the need to develop ‘buy-in’ from stakeholders and citizens.

Conclusions

Health systems want to ensure the use of high-value services to keep citizens healthy and avoid harm. Our synthesis can be used by policy-makers, stakeholders and researchers to understand how the issue has been prioritized, what approaches have been used to address it and implementation considerations.