Prevalence and determinants of defensive medicine among physicians: a systematic review and meta-analysis

Zheng, Junyao1,2; Lu, Yongbo3; Li, Wenjie1; Zhu, Bin4; Yang, Fan1,2,6; Shen, Jie5

2023-12-07

10.1093/intqhc/mzad096

INTERNATIONAL JOURNAL FOR QUALITY IN HEALTH CARE   影响因子和分区

1353-4505

1464-3677

Defensive medicine, characterized by physicians' inclination toward excessive diagnostic tests and procedures, has emerged as a significant concern in modern healthcare due to its high prevalence and detrimental effects. Despite the growing concerns among healthcare providers, policymakers, and physicians, comprehensive synthesis of the literature on the prevalence and determinants of defensive medicine among physicians has yet been reported. A comprehensive literature search was conducted to identify eligible studies published between 1 January 2000 and 31 December 2022, utilizing six databases (i.e. Web of Science, PubMed, Embase, Scopus, PsycINFO, and Cochrane Library). A meta-analysis was conducted to determine the prevalence and determinants of defensive medicine. Of the 8892 identified articles, 64 eligible studies involving 35.9 thousand physicians across 23 countries were included. The overall pooled prevalence of defense medications was 75.8%. Physicians engaged in both assurance and avoidance behaviors, with the most prevalent subitems being increasing follow-up and avoidance of high-complication treatment protocols. The prevalence of defensive medicine was higher in the African region [88.1%; 95% confidence interval (CI): 80.4%-95.8%] and lower-middle-income countries (89.0%; 95% CI: 78.2%-99.8%). Among the medical specialties, anesthesiologists (92.2%; 95% CI: 89.2%-95.3%) exhibited the highest prevalence. Further, the pooled odds ratios (ORs) of the nine factors at the individual, relational, and organizational levels were calculated, and the influence of previous experience in medical-legal litigation (OR: 1.65; 95% CI: 1.13-2.18) should be considered. The results of this study indicate a high global prevalence of defensive medicine among physicians, underscoring the necessity of implementing targeted interventions to reduce its use, especially in certain regions and specialties. Policymakers should implement measures to improve physicians' medical skills, enhance physician-patient communication, address physicians' medical-legal litigation fears, and reform the medical liability system. Future research should focus on devising and assessing interventions to reduce the use of defensive medicine and to improve the quality of patient care.

defensive medicine physician prevalence determinants systematic review

SCI ; SSCI

英语

其他

National Natural Science Foundation of China[72174118] ; Shanghai Philosophy and Social Science Project[2021ESH002]

Health Care Sciences & Services

Health Care Sciences & Services ; Health Policy & Services

WOS:001115913300001

OXFORD UNIV PRESS

SOCIAL SCIENCES, GENERAL

Web of Science

1.Shanghai Jiao Tong Univ, Sch Int & Publ Affairs, 1954 Huashan Rd, Shanghai 200030, Peoples R China
2.Shanghai Jiao Tong Univ, China Inst Urban Governance, 1954 Huashan Rd, Shanghai 200030, Peoples R China
3.Xi An Jiao Tong Univ, Sch Publ Policy & Adm, 28 West Xianning Rd, Xian 710049, Peoples R China
4.Southern Univ Sci & Technol, Sch Publ Hlth & Emergency Management, 1008 Xueyuan Rd, Shenzhen 518005, Guangdong, Peoples R China
5.Shanghai Jiao Tong Univ, Shanghai Peoples Hosp 6, Sch Med, 600 Yishan Rd, Shanghai 200030, Peoples R China
6.Shanghai Jiao Tong Univ, China Inst Urban Governance, Sch Int & Publ Affairs, Room 335, Xinjian Bldg, 1954 Huashan Rd, Shanghai 200030, Peoples R China

Zheng, Junyao,Lu, Yongbo,Li, Wenjie,et al. Prevalence and determinants of defensive medicine among physicians: a systematic review and meta-analysis[J]. INTERNATIONAL JOURNAL FOR QUALITY IN HEALTH CARE,2023,35(4).

Zheng, Junyao,Lu, Yongbo,Li, Wenjie,Zhu, Bin,Yang, Fan,&Shen, Jie.(2023).Prevalence and determinants of defensive medicine among physicians: a systematic review and meta-analysis.INTERNATIONAL JOURNAL FOR QUALITY IN HEALTH CARE,35(4).

Zheng, Junyao,et al."Prevalence and determinants of defensive medicine among physicians: a systematic review and meta-analysis".INTERNATIONAL JOURNAL FOR QUALITY IN HEALTH CARE 35.4(2023).