title: Evidence for underuse of effective medical services around the world.
abstract: Underuse-the failure to use effective and affordable medical interventions-is common and responsible for substantial suffering, disability, and loss of life worldwide. Underuse occurs at every point along the treatment continuum, from populations lacking access to health care to inadequate supply of medical resources and labour, slow or partial uptake of innovations, and patients not accessing or declining them. The extent of underuse for different interventions varies by country, and is documented in countries of high, middle, and low-income, and across different types of health-care systems, payment models, and health services. Most research into underuse has focused on measuring solutions to the problem, with considerably less attention paid to its global prevalence or its consequences for patients and populations. Although focused effort and resources can overcome specific underuse problems, comparatively little is spent on work to better understand and overcome the barriers to improved uptake of effective interventions, and methods to make them affordable.
authors.affiliation: Centre for Research in Evidence-Based Practice, Bond University, Robina, QLD, Australia. Electronic address: paul_glasziou@bond.edu.au.
authors.forename: Paul
authors.initials: P
authors.lastname: Glasziou
authors.affiliation: Li Ka Shing Knowledge Institute of St. Michael's Hospital, Department of Medicine, University of Toronto, Toronto, ON, Canada.
authors.forename: Sharon
authors.initials: S
authors.lastname: Straus
authors.affiliation: Lown Institute, Brookline, MA, USA.
authors.forename: Shannon
authors.initials: S
authors.lastname: Brownlee
authors.affiliation: Discipline of General Practice, School of Public Health, University of Sydney, Sydney, NSW, Australia.
authors.forename: Lyndal
authors.initials: L
authors.lastname: Trevena
authors.affiliation: University of the Philippines Manila, Manila, Philippines.
authors.forename: Leonila
authors.initials: L
authors.lastname: Dans
authors.affiliation: Department of Clinical Epidemiology & Biostatistics, McMaster University, Ontario, ON, Canada.
authors.forename: Gordon
authors.initials: G
authors.lastname: Guyatt
authors.affiliation: Menzies Centre for Health Policy, School of Public Health, University of Sydney, Sydney, NSW, Australia.
authors.forename: Adam G
authors.initials: AG
authors.lastname: Elshaug
authors.affiliation: Harvard Clinical and Translational Science Center, Boston, MA, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Janett
authors.affiliation: Lown Institute, Brookline, MA, USA.
authors.forename: Vikas
authors.initials: V
authors.lastname: Saini
mesh_terms: D004363:Drug Utilization / Q000706:statistics & numerical data; D019317:Evidence-Based Medicine; D014943:Global Health / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006300:Health Services Misuse / Q000706:statistics & numerical data*; D006302:Health Services Research / Q000379:methods; D006801:Humans; D008507:Medically Underserved Area; D010349:Patient Compliance / Q000706:statistics & numerical data