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Policy PointsDissemination of Choosing Wisely guidelines alone is unlikely to reduce the use of low‐value health services.Interventions by health systems to implement Choosing Wisely guidelines can reduce the use of low‐value services.Multicomponent interventions targeting clinicians are currently the most effective types of interventions. Context: Choosing Wisely aims to reduce the use of unnecessary, low‐value medical services through development of recommendations related to service utilization. Despite the creation and dissemination of these recommendations, evidence shows low‐value services are still prevalent. This paper synthesizes literature on interventions designed to reduce medical care identified as low value by Choosing Wisely and evaluates which intervention characteristics are most effective. Methods: We searched peer‐reviewed and gray literature from the inception of Choosing Wisely in 2012 through June 2019 to identify interventions in the United States motivated by or using Choosing Wisely recommendations. We also included studies measuring the impact of Choosing Wisely on its own, without interventions. We developed a coding guide and established coding agreement. We coded all included articles for types of services targeted, components of each intervention, results of the intervention, study type, and, where applicable, study quality. We measured the success rate of interventions, using chi‐squared tests or Wald tests to compare across interventions. Findings: We reviewed 131 articles. Eighty‐eight percent of interventions focused on clinicians only; 48% included multiple components. Compared with dissemination of Choosing Wisely recommendations only, active interventions were more likely to generate intended results (65% vs 13%, p < 0.001) and, among those, interventions with multiple components were more successful than those with one component (77% vs 47%, p = 0.002). The type of services targeted did not matter for success. Clinician‐based interventions were more effective than consumer‐based, though there is a dearth of studies on consumer‐based interventions. Only 17% of studies included a control arm. Conclusions: Interventions built on the Choosing Wisely recommendations can be effective at changing practice patterns to reduce the use of low‐value care. Interventions are more effective when targeting clinicians and using more than one component. There is a need for high‐quality studies that include active controls. [ABSTRACT FROM AUTHOR]

Child and maternal health, a key marker of overall health system performance, is a policy priority area by the World Health Organization and the United Nations, including the Sustainable Development Goals. Previous realist work has linked child and maternal health outcomes to globalization, political tradition, and the welfare state. It is important to explore the role of other key policy-related factors. This paper presents a realist synthesis, categorising policy instruments according to the established NATO model, to develop an explanatory model of how policy instruments impact child and maternal health outcomes. A systematic literature search was conducted to identify studies assessing the relationships between policy instruments and child and maternal health outcomes. Data were analysed using a realist framework. The first stage of the realist analysis process was to generate micro-theoretical initial programme theories for use in the theory adjudication process. Proposed theories were then adjudicated iteratively to produce a set of final programme theories. From a total of 43,415 unique records, 632 records proceeded to full-text screening and 138 papers were included in the review. Evidence from 132 studies was available to address this research question. Studies were published from 1995 to 2021; 76% assessed a single country, and 81% analysed data at the ecological level. Eighty-eight initial candidate programme theories were generated. Following theory adjudication, five final programme theories were supported. According to the NATO model, these were related to treasure, organisation, authority-treasure, and treasure-organisation instrument types. This paper presents a realist synthesis to develop an explanatory model of how policy instruments impact child and maternal health outcomes from a large, systematically identified international body of evidence. Five final programme theories were supported, showing how policy instruments play an important yet context-dependent role in influencing child and maternal health outcomes. • A realist synthesis was conducted. • Assessed relationship between policy instruments and child and maternal health. • Synthesis informed by 132 unique studies. • Five final programme theories were supported. • Impact of policy instruments was context-dependent. [ABSTRACT FROM AUTHOR]

For virtual care models to be able to improve the safety and quality of care, it is essential to identify the strengths and weaknesses of virtual care. In this Scoping review, literature published on virtual care was identified using international databases. The results of the included studies were summarized using a predefined taxonomy. In total, 20 studies were included in the present review. Extracting the findings of the articles showed four main topics, including "virtual care delivery models," "Video conference software platforms to provide virtual care," "virtual care delivery challenges," and "virtual care implementation facilitators." Therefore, with the development of emerging digital technologies, unique opportunities to provide virtual care and improve the provision of health services have been created in the health care system worldwide. Multifunctional video conference software platforms using specific models for each scope of care practice should be considered. [ABSTRACT FROM AUTHOR]

This article examines the political economy of health inequalities and inequities in the public health care system in India and identifies potential areas for interventions to promote equal and equitable health care for marginalized people. Drawing on the Political Economy of Health Model of Research, this article reiterates the inadequacy of policy frameworks and programs in ensuring accessible, affordable, and quality public health care services to all. We argue that for policies to be successful, policymakers should consider the diverse social registries of class, caste, religion, gender, region, ethnicity, and age, as well as their intersections. We also argue that health care policies and programs need to be: (a) dynamic and flexible, (b) intersectional and backed up by sufficient grassroots research, and (c) equitable at every stage of policy formulation, implementation, and evaluation. [ABSTRACT FROM AUTHOR]

Introduction: Economic evaluations are widely used tools that greatly contribute to evidence-based health policy and decision-making. However, economic evidence is not commonly used in the countries of the World Health Organization Eastern Mediterranean Region.Areas covered: The aim of this scoping review is to map the existing literature of health economic evaluation studies in the countries of the World Health Organization Eastern Mediterranean Region. Also, the review aims to identify the research gaps in the field of health economic evaluation in the region and finally provide recommendations for research and policy making. We searched six electronic databases. Six items were extracted from each of the included studies: first author, publication year, country of the study, study type, health technology assessed, and perspective.Expert opinion: The quality and quantity of HEE studies should be improved in the region. There is a need to follow evidence-based methodological rigor to aid in informed health-care decision-making and efficient use of health-care resources. [ABSTRACT FROM AUTHOR]