[Set them free! Better care for more patients with fewer follow-ups].

Background

In view of rising healthcare demands and limited personnel and financial resources, the targeted use of ophthalmological resources is becoming increasingly more important.

Objective

To present an approach for identifying dispensable diagnostic, therapeutic and monitoring-related services in ophthalmology as well as strategies for their de-implementation in clinical practice.

Methods

Concepts for avoiding overuse are discussed, including choosing wisely, the Association of the Scientific Medical Societies in Germany (AWMF) initiative "Gemeinsam Klug Entscheiden" (Choosing Wisely Together) and the comparison of national and international guidelines. In addition, the challenges of de-implementing established care routines are described.

Results

Evidence-based guidelines provide the basis for identifying dispensable diagnostic, therapeutic and monitoring-related measures. Their avoidance should be systematically considered in the development and updating of guidelines. The comparison of national and international recommendations can provide indications of dispensable services. For selected ophthalmological conditions, exemplary proposals for updating the guidelines are presented. The implementation requires the adaptation of established treatment pathways, the promotion of guideline adherence and the involvement of physicians, allied health professionals and patients.

Conclusion

The combination of guideline-assisted identification of dispensable services and structured de-implementation can contribute to a more targeted use of resources, reduce the care burden on ophthalmologists and improve the availability of ophthalmological services for patients with relevant treatment needs.