Broadening Risk Factor or Disease Definition as a Driver for Overdiagnosis: A Narrative Review
Autor(a) principal: | |
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Data de Publicação: | 2022 |
Outros Autores: | , , , , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
Texto Completo: | http://hdl.handle.net/10400.17/4343 |
Resumo: | Medical overuse-defined as the provision of health services for which potential harms exceed potential benefits-constitutes a paradigm of low-value care and is seen as a threat to the quality of care. Value in healthcare implies a precise definition of disease. However, defining a disease may not be straightforward since clinical data do not show discrete boundaries, calling for some clinical judgment. And, if in time a redefinition of disease is needed, it is important to recognize that it can induce overdiagnosis, the identification of medical conditions that would, otherwise, never cause any significant symptoms or lead to clinical harm. A classic example is the impact of recommendations from professional societies in the late 1990s, lowering the threshold for abnormal total cholesterol from 240 mg/dl to 200 mg/dl. Due to these changes in risk factor definition, literally overnight there were 42 million new cases eligible for treatment in the United States. The same happened with hypertension-using either the 2019 NICE guidelines or the 2018 ESC/ECC guidelines criteria for arterial hypertension, the proportion of people overdiagnosed with hypertension was calculated to be between 14% and 33%. In this review, we will start by discussing resource overuse. We then present the basis for disease definition and its conceptual problems. Finally, we will discuss the impact of changing risk factor/disease definitions in the prevalence of disease and its consequences in overdiagnosis and overtreatment (a problem particularly relevant when definitions are widened to include earlier or milder disease). |
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Broadening Risk Factor or Disease Definition as a Driver for Overdiagnosis: A Narrative ReviewChanging risk factor/disease definitionsDisease/definitionLow-value careOverdiagnosisOvertreatmenResource overuseHCC CIRMedical overuse-defined as the provision of health services for which potential harms exceed potential benefits-constitutes a paradigm of low-value care and is seen as a threat to the quality of care. Value in healthcare implies a precise definition of disease. However, defining a disease may not be straightforward since clinical data do not show discrete boundaries, calling for some clinical judgment. And, if in time a redefinition of disease is needed, it is important to recognize that it can induce overdiagnosis, the identification of medical conditions that would, otherwise, never cause any significant symptoms or lead to clinical harm. A classic example is the impact of recommendations from professional societies in the late 1990s, lowering the threshold for abnormal total cholesterol from 240 mg/dl to 200 mg/dl. Due to these changes in risk factor definition, literally overnight there were 42 million new cases eligible for treatment in the United States. The same happened with hypertension-using either the 2019 NICE guidelines or the 2018 ESC/ECC guidelines criteria for arterial hypertension, the proportion of people overdiagnosed with hypertension was calculated to be between 14% and 33%. In this review, we will start by discussing resource overuse. We then present the basis for disease definition and its conceptual problems. Finally, we will discuss the impact of changing risk factor/disease definitions in the prevalence of disease and its consequences in overdiagnosis and overtreatment (a problem particularly relevant when definitions are widened to include earlier or milder disease).WileyRepositório do Centro Hospitalar Universitário de Lisboa Central, EPEBandovas, JPLeal, BReis‐de‐Carvalho, CSousa, DCAraújo, JCPeixoto, PHenriques, SOVaz Carneiro, A2022-12-29T13:03:56Z20222022-01-01T00:00:00Zinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfhttp://hdl.handle.net/10400.17/4343engJ Intern Med . 2022 Apr;291(4):426-43710.1111/joim.13465info:eu-repo/semantics/openAccessreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAP2023-03-10T09:46:14Zoai:repositorio.chlc.min-saude.pt:10400.17/4343Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-19T17:21:40.276075Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse |
dc.title.none.fl_str_mv |
Broadening Risk Factor or Disease Definition as a Driver for Overdiagnosis: A Narrative Review |
title |
Broadening Risk Factor or Disease Definition as a Driver for Overdiagnosis: A Narrative Review |
spellingShingle |
Broadening Risk Factor or Disease Definition as a Driver for Overdiagnosis: A Narrative Review Bandovas, JP Changing risk factor/disease definitions Disease/definition Low-value care Overdiagnosis Overtreatmen Resource overuse HCC CIR |
title_short |
Broadening Risk Factor or Disease Definition as a Driver for Overdiagnosis: A Narrative Review |
title_full |
Broadening Risk Factor or Disease Definition as a Driver for Overdiagnosis: A Narrative Review |
title_fullStr |
Broadening Risk Factor or Disease Definition as a Driver for Overdiagnosis: A Narrative Review |
title_full_unstemmed |
Broadening Risk Factor or Disease Definition as a Driver for Overdiagnosis: A Narrative Review |
title_sort |
Broadening Risk Factor or Disease Definition as a Driver for Overdiagnosis: A Narrative Review |
author |
Bandovas, JP |
author_facet |
Bandovas, JP Leal, B Reis‐de‐Carvalho, C Sousa, DC Araújo, JC Peixoto, P Henriques, SO Vaz Carneiro, A |
author_role |
author |
author2 |
Leal, B Reis‐de‐Carvalho, C Sousa, DC Araújo, JC Peixoto, P Henriques, SO Vaz Carneiro, A |
author2_role |
author author author author author author author |
dc.contributor.none.fl_str_mv |
Repositório do Centro Hospitalar Universitário de Lisboa Central, EPE |
dc.contributor.author.fl_str_mv |
Bandovas, JP Leal, B Reis‐de‐Carvalho, C Sousa, DC Araújo, JC Peixoto, P Henriques, SO Vaz Carneiro, A |
dc.subject.por.fl_str_mv |
Changing risk factor/disease definitions Disease/definition Low-value care Overdiagnosis Overtreatmen Resource overuse HCC CIR |
topic |
Changing risk factor/disease definitions Disease/definition Low-value care Overdiagnosis Overtreatmen Resource overuse HCC CIR |
description |
Medical overuse-defined as the provision of health services for which potential harms exceed potential benefits-constitutes a paradigm of low-value care and is seen as a threat to the quality of care. Value in healthcare implies a precise definition of disease. However, defining a disease may not be straightforward since clinical data do not show discrete boundaries, calling for some clinical judgment. And, if in time a redefinition of disease is needed, it is important to recognize that it can induce overdiagnosis, the identification of medical conditions that would, otherwise, never cause any significant symptoms or lead to clinical harm. A classic example is the impact of recommendations from professional societies in the late 1990s, lowering the threshold for abnormal total cholesterol from 240 mg/dl to 200 mg/dl. Due to these changes in risk factor definition, literally overnight there were 42 million new cases eligible for treatment in the United States. The same happened with hypertension-using either the 2019 NICE guidelines or the 2018 ESC/ECC guidelines criteria for arterial hypertension, the proportion of people overdiagnosed with hypertension was calculated to be between 14% and 33%. In this review, we will start by discussing resource overuse. We then present the basis for disease definition and its conceptual problems. Finally, we will discuss the impact of changing risk factor/disease definitions in the prevalence of disease and its consequences in overdiagnosis and overtreatment (a problem particularly relevant when definitions are widened to include earlier or milder disease). |
publishDate |
2022 |
dc.date.none.fl_str_mv |
2022-12-29T13:03:56Z 2022 2022-01-01T00:00:00Z |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://hdl.handle.net/10400.17/4343 |
url |
http://hdl.handle.net/10400.17/4343 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
J Intern Med . 2022 Apr;291(4):426-437 10.1111/joim.13465 |
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info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
application/pdf |
dc.publisher.none.fl_str_mv |
Wiley |
publisher.none.fl_str_mv |
Wiley |
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reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação instacron:RCAAP |
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Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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RCAAP |
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RCAAP |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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