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Vol. 34. Issue 2.
Pages 51-114 (March - April 2019)
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Vol. 34. Issue 2.
Pages 51-114 (March - April 2019)
Review article
DOI: 10.1016/j.jhqr.2018.12.005
Defensive practices among non-medical health professionals: An overview of the scientific literature
Prácticas defensivas entre profesionales sanitarios no médicos: visión general de la bibliografía científica
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C. Rinaldia,b, A. D’Allevac,
Corresponding author
dallevaantonella@gmail.com

Corresponding author.
, F. Leigheba,b, K. Vanhaechtd,e, S. Knessea, F. Di Stanislaoc, M. Panellaa
a Department of Translational Medicine, School of Medicine, University of Eastern Piedmont, Novara, Italy
b A.O.U. Maggiore della Carità, Novara, Italy
c Department of Biomedical Sciences and Public Health, Section of Hygiene, Preventive Medicine and Public Health, Polytechnic University of Marche, Ancona, Italy
d Leuven Institute for Healthcare Policy, University of Leuven, Belgium
e Department of Quality Management, University Hospitals Leuven, Belgium
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Tables (4)
Table 1. Quality assessment of qualitative studies – EPPI-Center framework.
Table 2. Quality assessment of cross-sectional studies – NOS checklist.
Table 3. Key characteristics of included studies (n=14).
Table 4. Main findings of included studies (n=14).
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Abstract
Introduction

Defensive medicine (DM) is used when a doctor deviates from good practices to prevent complaints from patients or caregivers. This is a structured phenomenon that may not only affect the physician, but all healthcare personnel. The aim of this review was to determine whether DM is also performed by Non-Medical Health Professionals (NMHP), and the reasons, features, and effects of NMHP-DM.

Materials and methods

The review was conducted according to PRISMA guidelines, and specific inclusion criteria were used to search for relevant documents published up to 12 April 2018 in the main biomedical databases.

Results

A total of 91 potentially relevant studies were identified. After the removal of duplicates, 72 studies were screened for eligibility, separately by two of the authors. Finally, 14 qualitative and quantitative studies were considered relevant for the purpose of the present review. These last studies were assessed for their methodological quality.

Conclusions

NMHP-DM is quite similar to DM practiced by doctors, and is mainly caused by fear of litigation. Midwives and nursing personnel practiced both active and passive DM, such as over-investigation, over-treatment, and avoidance of high-risk patients. NMHP-DM could increase risks for patient health, costs, risk of burnout for healthcare employees. Further studies are needed to better understand prevalence and features of NMHP-DM in all health professional fields, in order to apply appropriate preventive strategies to contrast DM among health care personnel.

Keywords:
Defensive medicine
Defensive practice
Healthcare
Malpractice
Resumen
Introducción

Se denomina medicina defensiva (MD) a aquella que lleva a cabo un médico cuando se desvía de las buenas prácticas e intenta evitar las quejas de los pacientes o cuidadores. Este es un fenómeno organizado que no solo puede afectar al médico, sino también a todo el personal sanitario. El objetivo de esta revisión fue establecer si otros profesionales sanitarios no médicos (PSNM) también llevan a cabo MD y los motivos, las características y los efectos de la MD de los PSNM.

Materiales y métodos

La revisión se realizó de acuerdo con las directrices de PRISMA y se utilizaron criterios de inclusión específicos para buscar documentos importantes publicados hasta el 12 de abril de 2018 en las principales bases de datos biomédicas.

Resultados

Se identificaron un total de 91 estudios potencialmente importantes. Después de la eliminación de los duplicados, 72 de los estudios se analizaron detenidamente y por separado por dos de los autores. Finalmente, 14 estudios cualitativos y cuantitativos se consideraron importantes para la finalidad de esta revisión. Estos últimos estudios se evaluaron por su calidad metodológica.

Conclusiones

La MD de los PSNM es bastante similar a la MD practicada por los médicos, y se debe principalmente al temor a una demanda. Las comadronas y el personal de enfermería han practicado MD activa y pasiva, como la investigación excesiva, el tratamiento excesivo y la evitación de pacientes de alto riesgo. La MD de los PSNM podría aumentar los riesgos para la salud del paciente, los costes y el riesgo de agotamiento de los empleados sanitarios. Se necesitan estudios adicionales para comprender mejor la incidencia y las características de la MD de los PSNM en todos los campos de profesionales sanitarios a fin de aplicar estrategias preventivas adecuadas para comparar la MD entre el personal sanitario.

Palabras clave:
Medicina defensiva
Práctica defensiva
Asistencia sanitaria
Negligencia profesional

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