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Improving Adequacy in Endocrine Practice: Reducing Low-Value Care and Advancing Value-Based Medicine.

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Title: Improving Adequacy in Endocrine Practice: Reducing Low-Value Care and Advancing Value-Based Medicine.
Authors: Díez JJ; Department of Endocrinology, Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Spain.; Instituto de Investigación Sanitaria Puerta de Hierro Segovia de Arana, Majadahonda, Spain.; Department of Medicine, Universidad Autónoma de Madrid, Madrid, Spain.
Source: Journal of evaluation in clinical practice [J Eval Clin Pract] 2026 Oct; Vol. 32 (7), pp. e70687.
Publication Type: Journal Article; Review
Language: English
Journal Info: Publisher: Wiley-Blackwell Country of Publication: England NLM ID: 9609066 Publication Model: Print Cited Medium: Internet ISSN: 1365-2753 (Electronic) Linking ISSN: 13561294 NLM ISO Abbreviation: J Eval Clin Pract Subsets: MEDLINE
Imprint Name(s): Original Publication: Oxford, England : Wiley-Blackwell, c1995-
MeSH Terms: Endocrinology*/standards , Endocrinology*/organization & administration , Endocrinology*/economics , Quality Improvement*/organization & administration, Overdiagnosis/prevention & control ; Overtreatment/prevention & control ; Medical Overuse/prevention & control ; Humans ; Value-Based Health Care ; Evidence-Based Medicine
Abstract: Purpose: Low-value care represents a major and under-recognized threat to quality, safety, and sustainability in clinical endocrinology. This review aims to critically examine the role of overdiagnosis and overtreatment as key drivers of low-value care and to identify strategies to support the transition towards value-based endocrine practice.
Methods: We conducted a narrative review integrating current evidence on low-value care, overdiagnosis, and overtreatment in endocrinology. We also analyzed major international initiatives (e.g., Choosing Wisely, Right Care) and national programs, with particular focus on the "do not do" recommendations developed by the Spanish Society of Endocrinology and Nutrition (SEEN), as well as emerging frameworks from implementation and deimplementation science.
Results: Low-value practices are highly prevalent in endocrinology, driven by extensive use of diagnostic testing, evolving disease definitions, and uncertainty in clinical decision-making. These factors contribute to overdiagnosis and overtreatment, often triggering diagnostic-therapeutic cascades that increase patient harm, psychological burden, and healthcare costs without improving clinically meaningful outcomes. Although "do not do" recommendations and guideline-based initiatives provide actionable tools, their impact remains limited due to clinical inertia, cultural norms favoring intervention, and systemic barriers to deimplementation.
Conclusion: Reducing low-value care is essential to advancing high-quality, patient-centered endocrinology. This requires not only evidence-based recommendations but also transformative changes in clinical culture, clinician behavior, and healthcare systems, ensuring that care consistently maximizes benefit while minimizing harm.
(© 2026 John Wiley & Sons Ltd.)
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Contributed Indexing: Keywords: deimplementation; healthcare adequacy; low‐value care; overdiagnosis; overtreatment; value‐based endocrinology
Entry Date(s): Date Created: 20261018 Date Completed: 20261018 Latest Revision: 20261018
Update Code: 20261019
DOI: 10.1111/jep.70687
PMID: 42893545
Database: MEDLINE
Description
ISSN:1365-2753
DOI:10.1111/jep.70687