Our special collections assemble Cochrane Reviews on topics relevant to supporting a more sustainable approach to healthcare.
Overuse of medical diagnostics and treatments threaten the health of individuals and the sustainability of health systems in many countries. Unnecessary tests, treatments and diagnoses bring direct harms to people through adverse effects of interventions, psychosocial impacts of labelling, and overwhelming treatment burden. Medical excess also consumes scarce resources leading to underdiagnosis and underuse in other areas, indirectly harming patients. The idea underpinning our work as a Field is that tackling the crisis of medical excess, can reduce harm and wind back waste, making our health systems more sustainable. Our special collections aim to help users locate Cochrane reviews relevant within our Field.

Cochrane Special Collection series: Opportunities for de-implementing low value healthcare

Cochrane Sustainable Healthcare Field initiated an editorial collaborative project with Cochrane Argentina, Cochrane Chile, Cochrane Methodology Review Group, Evidence Aid, Cochrane Denmark and Cochrane Sweden. The project will produce a series of special collections assembling Cochrane reviews with the aim to create a platform highlighting ineffective or harmful interventions for to generate discussions of these interventions, and consequently actions to improve the sustainability in health care.

Special Collection 1: De-implementation of low-value health care: resource prioritization in the COVID-19 pandemic era (published September 2021)

This Special Collection brings together examples of resource-intense treatments and health care, which may be unlikely to be helpful and for which there is some evidence of harm to patients. It aims also to inform decisions when re-evaluating the necessity of certain procedures to ensure safety precautions needed for patients and healthcare workers due to COVID-19.
The COVID-19 pandemic has put huge pressure on health services. With so much attention and resource taken up by COVID-19, the health care available for people with problems not related to COVID-19 has declined in many countries (WHO, 2021). This will likely be the case for some time. Many people have had routine investigations and treatments postponed or cancelled and are facing delays in diagnosis and treatment.
The Special Collection is the first in a series of four collections with a focus on ensuring sustainability in healthcare. The Cochrane reviews include procedures where certain treatments and interventions are of questionable value to you as a patient and where there is a risk of medical overuse. It also aims to inform decisions to help wind back possible harmful or ineffective treatments that are in current use. The first Collection in this series is primarily aimed at healthcare professionals, healthcare policymakers and guideline developers. The Special Collection will be continually updated with new reviews.

The titles of the Cochrane systematic reviews included in this Collection are:

• General health checks in adults for reducing morbidity and mortality
• Routine preoperative medical testing for cataract surgery
• Subacromial decompression surgery for rotator cuff disease
• Percutaneous vertebroplasty for osteoporotic vertebral compression fracture
• Transfusion thresholds and other strategies for guiding allogeneic red blood cell transfusion
• Follow-up strategies for patients treated for non-metastatic colorectal cancer
• Recall intervals for oral health in primary care
• Routine scale and polish for periodontal health in adults

See also the accompanying editorial: Making wise choices about low-value health care in the COVID-19 pandemic; and Evidently Cochrane has also produced an accompanying blog ‘Choosing health care wisely when resources are scarce.

Special Collection 2: Achieving sustainable healthcare through deprescribing of unnecessary medications: making sense of the evidence (will be published during July 2022)

This Special Collection provides an overview of Cochrane Reviews that have attempted to summarize the potential benefits and harms of deprescribing specific medications as well as to inform how to implement deprescribing across different settings and populations. These reviews highlight that deprescribing is likely feasible and safe and can lead to benefits in prescribing and clinical outcomes. However, they also highlight significant gaps in the literature and methodological challenges to both conducting deprescribing studies and systematic reviews of deprescribing.

Cochrane Special Collection: Diagnosing Skin Cancer (published May 2020)

The Cochrane Reviews in this Special Collection focus on diagnosis of cutaneous melanoma, keratinocyte skin cancer and all types of skin cancer. This collection brings together a series of screening and diagnostic test accuracy systematic reviews for diagnosing skin cancer, which aim to identify the most accurate approaches to diagnosis, and so provide the best evidence on which clinical and policy-related decisions can be based.