Cari Almazán, Head of Essencial Project
Essencial (Essential), in our context, is a pioneering project. Introduced in March 2013, it was the first initiative in Catalonia and Spain created with the objective of identifying and making the necessary recommendations for the avoidance of little value clinical practice. This objective is not confined to solely generate a periodic list of recommendations. Essencial also aims to promote real change in clinical practice. To achieve this, complementary strategies to implement the recommendations and measure their impact have been developed.
What is meant by little value clinical practices?
It’s clear that, apart from clinical practices with proven effectiveness, other clinical practices take place, some of low value and some that do not provide any substantial value whatsoever. When talking about clinical practice of little value, we mean health interventions that are inappropriate in certain circumstances, either because they are ineffective or because there is no scientific evidence of effectiveness, either because the risks outweigh the benefits or there are alternatives that are more cost-effective. The consequences of inappropriate practice are increased overdiagnosis and overtreatment, as mentioned in the recent medical article Update on medical overuse, published in JAMA.
The next targets: implementing the recommendations and changing clinical practice
Essencial published thirty recommendations and more are on the way. A new phase takes place now and that’s the implementation of the recommendations. A general framework has been defined in which health professionals, with the managers’ and providers’ support, become the major change actors while clinical leadership in the implementation of the recommendations is emphasized. Clinical leaders, together with the care teams, identify and discuss in context clinical practice of little value. Taking into account the characteristics of each organization, a choice between the most suitable for recommendations is made and the most effective enforcements measures are decided upon. The generated monthly indicators will provide teams with information regarding clinical practice changes that may occur.
Currently a pilot project for implementing the Essencial’s recommendations in collaboration with Institut Català de la Salut (ICS) in 15 primary care teams (PCT) has been initiated. The clinical leaders of these PCT, have conducted the first session to identify barriers to implementation. The experience and results of this pilot will be available on the website of the Essencial project.
On the other hand, we must not forget that patients are also relevant decision makers when it comes to their needs and the demand for certain health services. Therefore, the recommendations’ implementation must be accompanied by a communication strategy aimed not only at patients but at the general public as well. This strategy has begun with the development of a patient record that accompanies each recommendation, with the dual aim to inform and reinforce the message of the healthcare professionals. Likewise, we must dig out the necessary skills and explore new tools and new communication channels for a more effective communication.
The start of this pilot is an important milestone in the project. The Essencial’s contribution to the quality and sustainability of the system, improving clinical practice and avoiding the waste of resources, will only be achieved with the recognition and complicity of health professionals and patients who add value to these recommendations.