Older Adults’ Perceptions of the Causes and Consequences of Healthcare Overuse: A Qualitative Study
Overuse of healthcare is pervasive in the United States, often exposing patients to harm with little likelihood of benefit. Older Americans are particularly vulnerable to overuse and impacted by it, yet it is unknown whether older patients perceive overuse as a consequential problem.
To explore the experiences and perspectives of older adults with respect to healthcare overuse in order to develop a framework for understanding and reducing overuse in older adults.
Qualitative study using focus group methodology.
Five focus groups were held with people ≥65 years of age (N = 38) in four senior centers in Baltimore, Maryland, in 2016.
Transcripts were analyzed using qualitative content analysis to identify major themes.
Of the 38 participants, 28 were women and 29 were African-American; 31 had at least a 12th grade education. While virtually all reported experience with what they perceived to have been healthcare overuse, some expressed concern that they had been denied appropriate care. They perceived overuse to have occurred when interventions were applied in the absence of symptoms (excluding cancer screening), did not improve symptoms, were discordant with their preferences, or were duplicative. Some defined overuse as interventions that were offered before less intensive options or too early in the course of disease. Suggested contributors to overuse were poor quality communication between patients and healthcare providers, and between different healthcare providers. Participants reported suffering from treatment effects, high costs, worry, and inconvenience from what they perceived to be overuse. They suggested that overuse may be reduced when the patient is involved in decision making and has a trusted primary care doctor.
The experience of older adults highlights potential sites of intervention to reduce healthcare overuse. Engaging patients in shared decision making and enhancing communication and knowledge transfer should be tested as interventions to reduce perceived overuse.
KEY WORDShealthcare overuse older adults qualitative research
This study was presented at the 5th Lown Institute Conference in Boston, MA, and at the 2017 Society of General Internal Medicine Annual Meeting in Washington, DC.
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they do not have a conflict of interest.
- 7.Agency for Healthcare Research and Quality. Glossary: Underuse, overuse, misuse. Available at: https://psnet.ahrq.gov/glossary/u. Acccessed 26 June 2017.
- 18.Crabtree BF, Miller W.L. Doing Qualitative Research. 2nd ed. Thousand Oaks: Sage Publications; 1999.Google Scholar
- 19.Krouss M, Croft L, Morgan DJ. Physician Understanding and Ability to Communicate Harms and Benefits of Common Medical Treatments. JAMA Intern Med. 2016;176(10):1565–67.Google Scholar
- 20.Agency for Healthcare Research and Quality. AHRQ Health Literacy Universal Precautions Toolkit. Available at: https://www.ahrq.gov/professionals/quality-patient-safety/quality-resources/tools/literacy-toolkit/index.html. Accessed 26 June 2017.
- 24.Thomas K. Mylan Chief’s Answers on EpiPen Frustrate House Panel. The New York Times. September 22, 2016: B3.Google Scholar
- 25.Bishop T. Judge upholds removal of Mark Midei’s medical license. The Baltimore Sun. May 8, 2012:2A.Google Scholar
- 26.Stepanczuk C, Williams N, Morrison K, Kemmerer C. Factors influencing patients' receptiveness to evidence-based recommendations during the clinical encounter. J Comp Eff Res. 2017. https://doi.org/10.2217/cer-2016-0077.
- 29.Elshaug AG, Rosenthal MB, Lavis JN, Brownlee S, Schmidt H, Nagpal S, et al. Levers for addressing medical underuse and overuse: achieving high-value health care. Lancet. 2017. https://doi.org/10.1016/S0140-6736(16)32586-7.