June 18, 2022

Empowerment
1400H - 1500H
objective - for Via Zoom
laypeople to have an
Health Issue understanding of the
Course– importance of Low-
Low-value value Medical Care:
Medical Care: (Unnecessary)
Prescription of Prescription of
Medications Medications in the
management of
their health.
 Empowerment
objective - for ROJoson PEP Talk
laypeople to have an
Health Issue understanding of the I have a Patient
Course– importance of Low- Empowerment
Low-value value Medical Care: Program in which I
Medical Care: like to empower the
(Unnecessary)
Prescription of lay people or
Prescription of patients to take
Medications Medications in the control in the
management of management of
their health. their health.
 There are 3 courses
in the PEP Talk.
I completed the Core
Course on October 9,
2021.
 From October 23,
2021 onwards, I have
been tackling Health
Disorder and Health
Issue Courses. This
may take 3 years or
longer.
 Empowerment My PEP TALK today
objective - for is entitled: Low-
laypeople to have an value Medical Care:
Health Issue understanding of the (Unnecessary)
Course– Prescription of
importance of Low-
Low-value Medications.
value Medical Care:
Medical Care: (Unnecessary)
Prescription of Prescription of This is part of the
Medications Medications in the Health Issue Course.
management of
their health.
 Contents of PEP TALK on Low-value Medical Care:
Health Issue
Prescription of Medications
Course–
• What is a low-value medical care?
Low-value • What are the different types of low-value medical
Medical Care: care?
Prescription of • What are the causes of low-value medical care?
Medications • How common are the low-value medical care?
• What is low-value prescription of medications?
• What are examples of low-value or unnecessary
prescription of medications?
• What are the causes and types of low-value or
unnecessary prescription of medications?
• What are tips on avoiding or reducing low-value or
unnecessary prescription of medications?
 • What is a low-value medical care?
Health Issue
Course–
Low-value
Medical Care:
Prescription of
Medications
 • What is a low-value medical care?
Health Issue
Course– Low-value medical care is defined as medical care
Low-value or services that provide little or no benefit to
Medical Care: patients, have potential to cause harm, incur
Prescription of unnecessary cost to patients, or waste limited
Medications healthcare resources.
 • What is a low-value medical care? NO or LITTLE
Health Issue
BENEFIT is in terms
Course– Low-value medical care is defined as medical care of effectiveness,
Low-value or services that provide little or no benefit to thus, NOT effective
Medical Care: patients, have potential to cause harm, incur in the goal of the
Prescription of unnecessary cost to patients, or waste limited medical service
Medications healthcare resources. rendered.
 • What is a low-value medical care? POTENTIAL TO
Health Issue
CAUSE HARM is in
Course– Low-value medical care is defined as medical care terms of RISKS for
Low-value or services that provide little or no benefit to UNWANTED side
Medical Care: patients, have potential to cause harm, incur effects or adverse
Prescription of unnecessary cost to patients, or waste limited effects,
Medications healthcare resources. complications, and
even death with the
medical service
rendered.
 • What is a low-value medical care? UNNECESSARY COST
Health Issue
TO PATIENTS is in
Course– Low-value medical care is defined as medical care terms of money
Low-value or services that provide little or no benefit to spent by patients
Medical Care: patients, have potential to cause harm, incur and families for the
Prescription of unnecessary cost to patients, or waste limited medical service
Medications healthcare resources. rendered which is
considered
UNNECESSARY.
 • What is a low-value medical care? WASTE LIMITED
Health Issue HEALTHCARE
Course– Low-value medical care is defined as medical care RESOURCES is in terms
Low-value or services that provide little or no benefit to of UNNECESSARY
Medical Care: patients, have potential to cause harm, incur USAGE of a FINITE
Prescription of unnecessary cost to patients, or waste limited government
Medications healthcare resources. FUNDING / BUDGET
for health of the
citizens like the
PhilHealth and
UNNECESSARY USAGE
of FINITE number of
services like hospital
beds, tests, and
 • What is a low-value medical care?
Health Issue
Course– Low-value medical care is defined as medical care
Low-value or services that provide little or no benefit to
Medical Care: patients, have potential to cause harm, incur
Prescription of unnecessary cost to patients, or waste limited
Medications healthcare resources.
Low-value medical care can be equated to
UNNECESSARY or NOT NEEDED medical care
rendered to patients primarily because of NO or
LITTLE BENEFIT and with POTENTIAL to cause
HARM and secondarily because of unnecessary
cost to patients and waste of limited healthcare
resources.
 • What is a low-value medical care?
Health Issue
Course– Low-value medical care is defined as medical care
Low-value or services that provide little or no benefit to
Medical Care: patients, have potential to cause harm, incur
Prescription of unnecessary cost to patients, or waste limited
Medications healthcare resources.

Low-value medical care can be equated to

UNNECESSARY or NOT NEEDED or NOT INDICATED
or NOT in the patient’s best interest when
weighed against other available options, including
watchful waiting and other more conservative
measures.
 • What is a low-value medical care? vs high-
Health Issue
value medical care?
Course–
Low-value
Medical Care: Low-value medical care is defined as medical care
Prescription of or services that provide little or no benefit to
Medications patients, have potential to cause harm, incur
unnecessary cost to patients, or waste limited
healthcare resources.

High-value medical care is providing the best

medical care possible, efficiently using resources,
and achieving optimal results for each patient.
 • What are the different types of low-value
Health Issue
medical care?
Course–
Low-value
Medical Care:
Prescription of
Medications
 • What are the different types of low-value
Health Issue
medical care?
Course–
Low-value • Low-value Medical Care: Unnecessary
Medical Care:
Prescription of
Medications
Medications • Low-value Medical Care: Unnecessary
Diagnostic Tests
• Low-value Medical Care: Unnecessary
Operations or Surgeries
 • What are the different types of low-value Low-
Health Issue
medical care? value prescription of
Course–
medications –
Low-value • Low-value Medical Care: Unnecessary
prescription of
Medical Care: Prescription of Medications medications that
Prescription of • Low-value Medical Care: Unnecessary provides little or no
Medications Diagnostic Tests benefit to patients,
• Low-value Medical Care: Unnecessary may be harmful,
Operations or Surgeries incur unnecessary
costs, and waste
healthcare
resources.
 • What are the different types of low-value Low-
Health Issue
medical care? value prescriptions
Course–
of medications –
Low-value • Low-value Medical Care: Unnecessary prescriptions of
Medical Care:
Prescription of
Prescription of Medications medications that
• Low-value Medical Care: Unnecessary
Examples: provide little or no
Medications
• Prescribing antibiotics for viral upper benefit to patients,
Diagnostic Tests
respiratory tract infection may be harmful,
•• Low-value Medicalfor
Prescribing antibiotics Care: Unnecessary
asymptomatic incur unnecessary
Operations
bacteriuria or Surgeries costs, and waste
• Prescribing vitamins and supplements when healthcare
they are not indicated. resources.
 • What are the different types of low-value Low-value diagnostic
Health Issue
medical care? tests – ordering of
Course–
Low-value • Low-value Medical Care: Unnecessary diagnostic tests that
Medical Care: Prescription of Medications provide little or no
Prescription of • Low-value Medical Care: Unnecessary benefit to patients,
Medications Diagnostic Tests may be harmful,
• Low-value Medical Care: Unnecessary incur unnecessary
Operations or Surgeries costs and waste
healthcare
resources. 
 • What are the different types of low-value Low-value diagnostic
Health Issue
medical care? tests – ordering of
Course–
Low-value diagnostic tests that
• Low-value Medical Care: Unnecessary
Medical Care: provide little or no
Prescription of
Diagnostic Tests benefit to patients,
Medications • Low-value Medical Care: Unnecessary
Examples: may be harmful,
• Ordering preoperative
Operations tests (for clearance)
or Surgeries incur unnecessary
prior to low-risk surgeries costs and waste
• Ordering MRI for non-specific low back pain
healthcare
resources. 
 • What are the different types of low-value Low-value operations
Health Issue
medical care? or surgeries –
Course–
Low-value performance of
• Low-value Medical Care: Unnecessary
Medical Care: operations or
Prescription of Medications
Prescription of surgeries that
• Low-value Medical Care: Unnecessary
Medications provide little or no
Diagnostic Tests
benefit to patients,
• Low-value Medical Care: Unnecessary
may be harmful,
Operations or Surgeries
incur unnecessary
costs and waste
healthcare resources.
 • What are the different types of low-value Low-value operations
Health Issue
medical care? or surgeries –
Course–
Low-value performance of
• Low-value Medical Care: Unnecessary operations or
Medical Care:
Prescription of
Operations or Surgeries surgeries that
Medications Examples: provide little or no
• Circumcision benefit to patients,
• Cholecystectomy for asymptomatic gallbladder may be harmful,
stones incur unnecessary
• Cholecystectomy for gallbladder polyps costs and waste
healthcare resources.
 • What are the causes of low-value medical
Health Issue
care?
Course–
Low-value
Medical Care:
Prescription of
Medications
 • What are the causes of low-value medical
Health Issue
care?
Course–
Low-value 3 factors:
Medical Care: • Primary factor: Physician-driven factors
Prescription of • Secondary factor: Patient-or-consumer driven
Medications factors
Health systems that facilitate practice of low-
value medical care is another factor which may be
more intimately related to the physician-driven
factors (example: no quality control,
incentivization). They may also be related to
patient-driven factors (example: no adequate
patient education).
 • What are the causes of low-value medical
Health Issue
care?
Course–
Low-value Factors:
Medical Care: • Primary factor: Physician-driven factors
Prescription of • Secondary factor: Patient-or-consumer-driven
Medications factors
Physicians are the primary factor because of their
greater influencing power in promoting / avoiding
low-value / unnecessary medical care. Patients or
They “call the shot” so to speak. consumers generally
They are the consultants and recommenders. follow advice of
They are the prime movers, primary actors. physicians.
 • What are the causes of low-value medical Patients or
Health Issue
care? consumers are the
Course–
secondary factor
Low-value Factors: because of their
Medical Care: • Primary factor: Physician-driven factors mindset and desires
Prescription of • Secondary factor: Patient-or-consumer-driven which the physicians
Medications factors want to satisfy above
anything else and
which usually lead to
low-value medical
care.
 • What are the causes of low-value medical
Health Issue
care?
Course–
Low-value Physician-driven factors
Medical Care: • Mindset in medical management – ritualistic
Prescription of and maximalist physicians
Medications • Financial gain – incentivized or non- More business than
incentivized (personal) compassion sense
• Wish to please patients or consumers – their
mindsets and desires over the rationalization of
care
• Fear of malpractice suits
• NO clear presentation and discussion of
options of management
 • What are the causes of low-value medical
Health Issue
care?
Course–
Low-value There are 3 types of physicians based on their
Medical Care: approach to medical problem-solving, decision-
Prescription of making and recommendations: (MINDSETS)
Medications • RITUALIST physicians
• MAXIMALIST physicians
• MINIMALIST physicians
 • What are the causes of low-value medical RITUALIST physicians
Health Issue
care? are those who make
Course–
medical
Low-value There are 3 types of physicians based on their management
Medical Care: approach to medical problem-solving, decision- decisions based on
Prescription of making and recommendations: (MINDSET) HABITS and not
Medications • RITUALIST physicians mainly on CRITICAL
• MAXIMALIST physicians ANALYSIS. 
• MINIMALIST physicians

LOW-VALUE
MEDICAL CARE
 • What are the causes of low-value medical MAXIMALIST
Health Issue
care? physicians are those
Course–
who institute medical
Low-value There are 3 types of physicians based on their management that
Medical Care: approach to medical problem-solving, decision- includes a lot of things
Prescription of making and recommendations: (MINDSETS) that are NOT essential
Medications • RITUALIST physicians Nice to have and needed by a
• MAXIMALIST physicians patient in health
• MINIMALIST physicians restoration and
maintenance. 

LOW-VALUE
MEDICAL CARE
 • What are the causes of low-value medical MINIMALIST
Health Issue
care? physicians are those
Course–
who institute medical
Low-value There are 3 types of physicians based on their management that
Medical Care: approach to medical problem-solving, decision- includes only which
Prescription of making and recommendations: (MINDSETS) are essential and
Medications • RITUALIST physicians needed by a patient in
• MAXIMALIST physicians health restoration and
• MINIMALIST physicians maintenance.

HIGH-VALUE
MEDICAL CARE
 • What are the causes of low-value medical FINANCIAL GAIN –
Health Issue
care? incentivized by a
Course–
system in the health
Low-value Physician-driven factors care institutions –
Medical Care: • Mindset in medical management – ritualistic with rewards such as
Prescription of and maximalist physicians stock dividends,
Medications • Financial gain – incentivized or non- perks, free trip
incentivized (personal) abroad, etc.
• Wish to please patients or consumers – their
mindset over the rationalization of care
• Fear of malpractice suits
• NO clear presentation and discussion of
options of management
 • What are the causes of low-value medical FINANCIAL GAIN –
Health Issue
care? non-incentivized but
Course–
with enrichment on a
Low-value Physician-driven factors personal basis – such
Medical Care: • Mindset in medical management – ritualistic as from more
Prescription of and maximalist physicians revenues from
Medications • Financial gain – incentivized or non- personally own
incentivized (personal) pharmacy or
• Wish to please patients or More business
consumers than
– their diagnostic business;
compassion
mindset over the rationalization of caresense want more revenues
• Fear of malpractice suits with procedures
• NO clear presentation and discussion of rather than
options of management medications; etc.
 • What are the causes of low-value medical Pleasing patients on
Health Issue
care? their mindsets and
Course–
desires rather than
Low-value Physician-driven factors explaining, educating
Medical Care: • Mindset in medical management – ritualistic and convincing them
Prescription of and maximalist physicians on rationalization of
Medications • Financial gain – incentivized or non- care.
incentivized (personal)
• Wish to please patients or consumers – their
mindset and desires over the rationalization of
care
• Fear of malpractice suits
• NO clear presentation and discussion of
options of management
 • What are the causes of low-value medical Fear of malpractice
Health Issue
care? suits if undue
Course–
development occurs
Low-value Physician-driven factors and when they do
Medical Care: • Mindset in medical management – ritualistic not accede to the
Prescription of and maximalist physicians unfounded mindsets
Medications • Financial gain – incentivized or non- and desires of the
incentivized (personal) patients and
• Wish to please patients or consumers – their relatives.
mindset and desires over the rationalization of
care
• Fear of malpractice suits
• NO clear presentation and discussion of
options of management
 • What are the causes of low-value medical NO presentation and
Health Issue
care? discussion of BRCA
Course–
data and processes in
Low-value Physician-driven factors selection of cost-
Medical Care: • Mindset in medical management – ritualistic effective option.
Prescription of and maximalist physicians B – benefit
Medications • Financial gain – incentivized or non- R – risk
incentivized (personal) C – cost
• Wish to please patients or consumers – their A – availability
mindset and desires over the rationalization of
care Options B - R - C - A
• Fear of malpractice suits 1
• NO clear presentation and discussion of 2
options of management 3
 • What are the causes of low-value medical NO presentation and
Health Issue
care? discussion of BRCA
Course–
data and processes in
Low-value Physician-driven factors selection of cost-
Medical Care: • Mindset inNOTE:
medical management – ritualistic
Prescription of High-value medical care effective option.
and maximalist physicians B – benefit
Medications looks for most cost-effective
• Financial gain – incentivized or non-
option and not just most R – risk
incentivized (personal) C – cost
effective
• Wish to please option.
patients or consumers – their A – availability
mindset and desires over the rationalization of
care Options B - R - C - A
• Fear of malpractice suits 1
• NO clear presentation and discussion of 2
options of management 3
 • What are the causes of low-value medical NO presentation and
Health Issue
care? discussion of BRCA
Course–
data and processes in
Low-value Physician-driven factors
NOTE: High-value medical care looks for most cost-effective
selection of cost-
Medical Care: •option and not
Mindset injust most effective
medical option. – ritualistic
management
Options Benefit Risk Cost Availability effective option.
Prescription of and maximalist physicians
 Treatment B – benefit
Medications • Medications
Financial gain – incentivized or non-
 Diagnostic R – risk
incentivized (personal)
Tests
C – cost
 Procedures /
• Operations
Wish to please patients or consumers – their A – availability
mindset and
Option 1  
desires  over the  rationalization
 
of
care
Option 2         Options B - R - C - A
• Fear
Option 3 of malpractice
   suits    
1
• NO clear presentation and discussion of 2
options of management 3
 • What are the causes of low-value medical
Health Issue
care?
Course–
Low-value Patient-or-consumer-driven factors
Medical Care: • Mindset and desires of patients
Prescription of
Medications
 • What are the causes of low-value medical
Health Issue
care?
Course–
Low-value There are 3 types of patients based on their
Medical Care: approach to medical problem-solving and
Prescription of decision-making: (MINDSETS and DESIRES)
Medications • RITUALIST patients
• MAXIMALIST patients
• MINIMALIST patients
 • What are the causes of low-value medical RITUALIST patients
Health Issue
care? are those who make
Course–
medical management
Low-value There are 3 types of patients based on their decisions based on
Medical Care: approach to medical problem-solving and HABITS, FADS, and
Prescription of decision-making: (MINDSET and DESIRES) not mainly on
Medications • RITUALIST patients CRITICAL ANALYSIS. 
• MAXIMALIST patients
• MINIMALIST patients

LOW-VALUE
MEDICAL CARE
 • What are the causes of low-value medical MAXIMALIST patients
Health Issue
care? are those who desire
Course–
medical management
Low-value There are 3 types of patients based on their that includes a lot of
Medical Care: approach to medical problem-solving and things that are NOT
Prescription of decision-making: (MINDSET and DESIRES) essential and needed
Medications • RITUALIST patients “Nice to have” by a patient in health
• MAXIMALIST patients restoration and
• MINIMALIST patients maintenance. 

LOW-VALUE
MEDICAL CARE
 • What are the causes of low-value medical MINIMALIST patients
Health Issue
care? are those who desire
Course–
medical management
Low-value There are 3 types of patients based on their that includes only
Medical Care: approach to medical problem-solving and which are essential
Prescription of decision-making: (MINDSET and DESIRES) and needed by a
Medications • RITUALIST patients patient in health
• MAXIMALIST patients restoration and
• MINIMALIST patients maintenance.

HIGH-VALUE
MEDICAL CARE
 • How common are the low-value medical care?
Health Issue
Course–
Low-value
Medical Care:
Prescription of
Medications
 • How common are the low-value medical care?
Health Issue
Course– • Very common abroad and in the Philippines
Low-value • Present since time immemorial
Medical Care: • Since start of medical profession (BCE) up to
Prescription of
now (CE) when physicians and health care
Medications
institutions and patients are NOT conscious of
low-value medical care
• Formal movement advocating high-
value and reducing low-value medical
care initiated only when government
health financing system was being
challenged
 Spreading globally across
• How common are the low-value medical care? Europe and Asia to over
Health Issue
20 countries around the
Course–
A popular movement – Choose Wisely (USA – world.
Low-value
2012) - Mission is to promote conversations
Medical Care: • Now there is
Prescription of between clinicians and patients by helping
formal tracking of
Medications patients choose care that is:
low-value medical
 Supported by evidence care in hospitals in
USA, England,
 Not duplicative of other tests or Australia, New
procedures already received Zealand, to name a
 Free from harm few.
• None yet in the
 Truly necessary Philippines.
 • How common are the low-value medical care? NO presentation and
Health Issue
discussion of BRCA
Course–
VERY COMMON because in practically all data and processes in
Low-value
prescriptions of medications; ordering of selection of cost-
Medical Care:
diagnostic tests; and performance of operations effective option.
Prescription of
or surgeries, there is ALWAYS a potential or risk of B – benefit
Medications
low-value medical care because of physician-, R – risk
patient- and health systems-driven factors. C – cost
A – availability
Particularly, when physicians do not
Options B - R - C - A
present and discuss BRCA data and 1
processes with patients. 2
3
 • LOW-VALUE OR UNNECESSARY PRESCRIPTION Today, in this
Health Issue
OF MEDICATIONS ROJoson PEP Talk,
Course–
we will focus on low-
Low-value
value or unnecessary
Medical Care:
prescription of
Prescription of
medications.
Medications
I will discuss low-
value or unnecessary
diagnostic tests and
surgeries in
subsequent sessions.
 • What is low-value or unnecessary prescriptions
Health Issue
of medications?
Course–
Low-value
Medical Care:
Prescription of
Medications
 • What is low-value or unnecessary prescription
Health Issue
of medications?
Course–
Low-value
Medical Care: Low-value prescriptions of medications –
Prescription of prescription of medications that provides
Medications
little or no benefit to patients, may be
harmful, incur unnecessary costs, and
waste healthcare resources.
 • How common is low-value or unnecessary
Health Issue
prescription of medications?
Course–
Low-value
Medical Care:
Prescription of
Medications
 • How common is low-value or unnecessary Low-value Medical
Health Issue
prescription of medications? Care:
Course–
Low-value • Unnecessary
Medical Care: Among the three types of low-value medical care, Medications
Prescription of • Unnecessary
Medications low-value prescription of medications is Diagnostic Tests
most frequent (No. 1) • Unnecessary
Operations or
as drugs or medications are the most common Surgeries
and readily available resources used by physicians
and patients alike in managing health problems.
 • What are the causes of low-value prescription
Health Issue
of medications?
Course–
Low-value
Medical Care:
Prescription of
Medications
 • What are the causes of low-value prescription
Health Issue
of medications?
Course–
Low-value 3 factors:
Medical Care: • Primary factor: Physician-driven factors
Prescription of • Secondary factor: Patient-or-consumer driven
Medications factors
• Tertiary factor: Health systems factors
 • What are the causes of low-value prescription
Health Issue
of medications?
Course–
Low-value Physician-driven factors
Medical Care: • Mindset in medical management – ritualistic
Prescription of and maximalist physicians
Medications • Financial gain – incentivized or non- More business than
incentivized (personal) compassion sense
• Wish to please patients or consumers – their
mindsets and desires over the rationalization of
care
• Fear of malpractice suits
• NO clear presentation and discussion of
options of management
 • What are the causes of low-value prescription
Health Issue
of medications?
Course–
Low-value Patient-or-consumer-driven factors
Medical Care: • Mindset and desires of patients
Prescription of
Medications
 • What are the causes of low-value prescription
Health Issue
of medications?
Course–
Low-value Health system factors
Medical Care: • Facilitating, allowing, no policing, no quality
Prescription of control of practices of physicians
Medications • Inadequate public health education, patient-
centered care management program or
patient-empowerment program
 • What are the types of low-value prescription of
Health Issue
medications?
Course–
Low-value
Medical Care:
Prescription of
Medications
 • What are the types of low-value prescriptions
Health Issue
of medications?
Course–
Low-value
Prescriptions of medicines that are:
Medical Care:
• Not needed (just watchful waiting will do)
Prescription of
• Inappropriate to use (not indicated)
Medications
• Not proven effective
• Unsafe for all patients and to certain patients
• Costlier than other equivalently effective drugs

• Being prescribed too long

• Too many (>5 – polypharmacy)
 • What are examples of low-value or NO presentation and
Health Issue
unnecessary prescription of medications? discussion of BRCA
Course–
data and processes in
Low-value Here, I will just give a few examples. selection of cost-
Medical Care:
effective option.
Prescription of Remember what I said earlier: B – benefit
Medications
In practically all prescriptions of medications, R – risk
there is ALWAYS a potential or risk of low-value C – cost
medical care because of physician-driven, A – availability
patient-driven and health systems-driven factors. Options B - R - C - A
Particularly, when physicians do not present and discuss
1
BRCA data and processes with patients. 2
3
 • What are examples of low-value or
Health Issue
unnecessary prescriptions of medications?
Course–
Low-value In the Choose Wisely website, one can see
Medical Care: hundreds (this is still partial) of examples of low-
Prescription of value or unnecessary prescriptions of medications
Medications which they are trying to educate the physicians
and public to avoid.

Link:
https://www.choosingwisely.org/clinician-lists/
 • What are examples of low-value or Low-
Health Issue
unnecessary prescription of medications? value prescriptions
Course–
of medications –
Low-value Examples: prescriptions of
Medical Care: • Prescribing antibiotics for viral upper medications that
Prescription of respiratory tract infection provide little or no
Medications • Prescribing antibiotics for asymptomatic benefit to patients,
bacteriuria may be harmful,
• Prescribing vitamins and supplements even incur unnecessary
when they are not indicated. costs, and waste
healthcare
resources.
 • What are examples of low-value or Low-
Health Issue
unnecessary prescription of medications? value prescriptions
Course–
of medications –
Low-value Examples: prescriptions of
Medical Care: • Oral antibiotics for ear infections (eardrops medications that
Prescription of preferred) provide little or no
Medications • Cough and cold medicines should not be benefit to patients,
prescribed, recommended or used for may be harmful,
respiratory illnesses in young children. incur unnecessary
costs, and waste
healthcare
resources.
 • What are examples of low-value or Low-
Health Issue
unnecessary prescription of medications? value prescriptions
Course–
of medications –
Low-value Examples: prescriptions of
Medical Care: • benzodiazepine use in the elderly medications that
Prescription of • antipsychotic use in dementia  provide little or no
Medications • prescribing two or more antipsychotics benefit to patients,
concurrently may be harmful,
incur unnecessary
costs, and waste
healthcare
resources.
 • What are examples of low-value or Low-
Health Issue
unnecessary prescription of medications? value prescriptions
Course–
of medications –
Low-value Examples: prescriptions of
Medical Care:
medications that
Prescription of Don’t prescribe or routinely continue medications provide little or no
Medications for older adults with limited life expectancy benefit to patients,
without due consideration to individual goals of may be harmful,
care, presence of comorbidities and time-to- incur unnecessary
benefit for preventive medications. costs, and waste
healthcare
resources.
 • What are examples of low-value or Low-
Health Issue
unnecessary prescription of medications? value prescriptions
Course–
of medications –
Low-value Examples:
prescriptions of
Medical Care: Do not routinely prescribe VTE (venous
medications that
Prescription of thromboembolism) prophylaxis to all hospitalized
provide little or no
Medications patients; use an evidence-based risk stratification
benefit to patients,
system to determine whether a patient needs VTE
may be harmful,
prophylaxis. If they do warrant prophylaxis, use a
incur unnecessary
bleeding risk assessment to determine if
costs, and waste
mechanical rather than pharmacologic
healthcare
prophylaxis is more appropriate.
resources.
 • What are examples of low-value or Low-
Health Issue
unnecessary prescription of medications? value prescriptions
Course–
of medications –
Low-value Examples:
prescriptions of
Medical Care:
medications that
Prescription of Don’t initiate medications to treat new and
provide little or no
Medications emerging symptoms without first ascertaining
benefit to patients,
that the new symptom is not an adverse drug
may be harmful,
event of an already prescribed medication.
incur unnecessary
costs, and waste
healthcare
resources.
 • What are examples of low-value or NO presentation and
Health Issue
unnecessary prescription of medications? discussion of BRCA
Course–
I just mentioned a few examples. data and processes in
Low-value
selection of cost-
Medical Care:
Mind you -- VERY VERY COMMON because in effective option.
Prescription of
practically all prescriptions of medications, there B – benefit
Medications
is ALWAYS a potential or risk of low-value medical R – risk
C – cost
care because of physician-driven, patient-driven
A – availability
and health systems-driven factors.
Options B - R - C - A
Particularly, when physicians do not present and 1
discuss BRCA data and processes with patients. 2
3
 • What are tips on avoiding or reducing low-
Health Issue
value or unnecessary prescriptions of
Course–
medications?
Low-value
Medical Care:
Prescription of
Medications
 • What are tips on avoiding or reducing low-
Health Issue
value or unnecessary prescriptions of
Course–
medications?
Low-value
Medical Care:
Prescription of 3 factors on the causes:
Medications • Primary factor: Physician-driven factors
• Secondary factor: Patient-or-consumer driven
factors
• Tertiary factor: Health systems factors

What can you do as a layperson or patient?

 • What are tips on avoiding or reducing low- Doctors and health
Health Issue
value or unnecessary prescriptions of institutions are
Course–
medications? trying to police
Low-value
themselves now
Medical Care:
3 factors on the causes: because of the
Prescription of
• Primary factor: Physician-driven factors Choose Wisely
Medications
• Secondary factor: Patient-or-consumer driven movement (started
factors in 2012).
• Tertiary factor: Health systems factors
• How long will it
take?
• How successful
What can you do as a layperson or patient? will it be?
 • What are tips on avoiding or reducing low-
Health Issue
value or unnecessary prescriptions of
Course–
medications?
Low-value
Medical Care:
Prescription of 3 factors on the causes:
Medications • Primary factor: Physician-driven factors
• Secondary factor: Patient-or-consumer driven You can do
factors your part here!
• Tertiary factor: Health systems factors For your own
sake!
For your
brethens’ sake!
What can you do as a layperson or patient?
 • What are tips on avoiding or reducing low- BE EMPOWERED AS
Health Issue
value or unnecessary prescriptions of A PATIENT!
Course–
medications?
Low-value
ADVOCATE PATIENT
Medical Care:
3 factors on the causes: EMPOWERMENT!
Prescription of
Medications • Primary factor: Physician-driven factors
• Secondary factor: Patient-or-consumer driven You can do
factors your part here!
• Tertiary factor: Health systems factors For your own
sake!
For your
brethens’ sake!
What can you do as a layperson or patient?
 Be always in touch with reliable medical
Health Issue HIGH-VALUE
information on low-value (unnecessary) and high-
Course– MEDICAL CARE
value (highly recommended) medical care.
Low-value
Medical Care:
Prescription of Knowledge is power; it gives power. Low-value Medical
Medications Use the 4Ks of Patient Empowerment: Care:
Kaalaman, Kakayanan, Karapatan and • Unnecessary
Kapangyarihan Medications
• Unnecessary
to gain greater control over decisions in
Diagnostic Tests
medical management of oneself in
• Unnecessary
promoting high-value medical care and Operations or
avoiding low-value medical care. Surgeries
 • What are tips on avoiding or reducing low-
Health Issue
value or unnecessary prescriptions of
Course–
medications?
Low-value
Medical Care: Strategies:
Prescription of
• Be constantly aware of and vigilant against
Medications
potential for low-value prescriptions of
medications to be done by physicians. Always
aim and insist for a high-value prescription
from the physicians.
 • What are tips on avoiding or reducing low-
Health Issue
value or unnecessary prescriptions of
Course–
medications?
Low-value
Medical Care: Strategies:
Prescription of
• Be proactive in controlling and avoiding low-
Medications
value prescriptions of medications. Make the
physicians aware that you know the processes
on how to reduce low-value and how to
promote high-value prescriptions. Have a
shared collaboration with the physicians in
accomplishing these.
 • What are tips on avoiding or reducing low-
Health Issue
value or unnecessary prescriptions of
Course–
medications?
Low-value
Medical Care: Strategies:
Prescription of
Medications • Before accepting the prescriptions, ask the
physician:
• What is specific pretreatment diagnosis
with quantification of degree of certainty
or probability?
• What is the goal of treatment?
 • What are tips on avoiding or reducing low-
Health Issue
value or unnecessary prescriptions of
Course–
medications?
Low-value
Medical Care: Strategies:
Prescription of
Medications • Before accepting the prescriptions, ask the physician:
• What are the options for treatment? (watchful waiting,
medications, operations, etc.)
• Is watchful waiting without medications a good option? What
are the chances the medical condition / disease will resolve
spontaneously? If more than 50%, watchful waiting is a good
option.
 • What are tips on avoiding or reducing low-
Health Issue
value or unnecessary prescriptions of
Course–
medications?
Low-value
Medical Care: Strategies:
Prescription of • Before accepting the prescriptions, ask the
Medications
physician:
• What are the comparative data and
information on the various options in
terms of benefit (effectiveness); risk; cost;
and availability parameters? What is his
recommendation on the cost-effective
option?
 • What are tips on avoiding or reducing low-
Health Issue
value or unnecessary prescriptions of
Course–
medications?
Low-value
Medical Care: Always use BRCA Process in selecting cost-
Prescription of effective treatment (medications, diagnostic tests,
Medications operations, watchful waiting, etc.)
Options Benefit Risk Cost Availability
 Treatment
 Medications
 Diagnostic
Tests
 Procedures /
Operations

Option 1        
Option 2        
Option 3        
 • What are tips on avoiding or reducing low-
Health Issue
value or unnecessary prescriptions of
Course–
medications?
Low-value
Medical Care: Strategies:
Prescription of
Medications • Before accepting the prescriptions, ask the physician:
• If medications will be used, what are the
comparative data and information on the various
options of medicines in terms of benefit
(effectiveness); risk; cost; and availability
parameters? What is his recommendation on the
cost-effective option?
 • What are tips on avoiding or reducing low-
Health Issue
value or unnecessary prescriptions of
Course–
medications?
Low-value
Medical Care: Always use BRCA Process in selecting cost-
Prescription of effective medications.
Medications
Options Benefit Risk Cost Availability
 Medications
Option 1        
Option 2        
Option 3        
 • What are tips on avoiding or reducing low-
Health Issue
value or unnecessary prescriptions of
Course–
medications?
Low-value
Medical Care: Strategies:
Prescription of
Medications • Before accepting the prescriptions, ask the physician:
• When the physician asks for your response to his
recommendation, feel free to ask as many questions
that you may have on the data and information
presented and also, asks him to temper and validate
your personal biases (mindset and desires) in favor of
an objective decision-making.
 • What are tips on avoiding or reducing low-
Health Issue
value or unnecessary prescriptions of
Course–
medications?
Low-value
Medical Care: Strategies:
Prescription of
Medications • You are free and have a right to seek a
second opinion if you want. However, when
you do this, follow the same processes
mentioned above.
 • What are tips on avoiding or reducing low-
Health Issue
value or unnecessary prescriptions of
Course–
medications?
Low-value
Medical Care: Illustration:
Prescription of
Medications A 30-year-old Filipino female (Anna) with a recent
onset of cough, colds, and fever. An RT-PCR for
COVID19 showed positive result. Anna has no co-
morbidity. She consulted a physician (Dr. Rey).
 • What are tips on avoiding or reducing low-
Health Issue
value or unnecessary prescriptions of
Course–
medications?
Low-value
Medical Care: Illustration:
Prescription of
Medications After fully evaluating Anna, Dr. Rey gave a
statement on diagnosis:
COVID19 positive, symptomatic (cough, colds and
fever), mild, with no co-morbidity.

Dr. Rey also gave a good prognosis for recovery.

 • What are tips on avoiding or reducing low-
Health Issue
value or unnecessary prescriptions of
Course–
medications?
Low-value
Medical Care: Illustration:
Prescription of
Medications Dr. Rey recommended the following management
regimen:
 • What are tips on avoiding or reducing low-
Health Issue
value or unnecessary prescriptions of
Course–
medications?
Low-value
Medical Care: Illustration:
Prescription of
• Isolation up to (DATE)
Medications • Body Resistance-Immunity Build-up and Maintenance
(using ROJoson Regimen – rest/sleep (10 hours);
hydration (10 glasses of water); nutrition (balanced,
varied diet with plenty of vegetable and fruits); exercise
(light-to-moderate intensity – one hour – 30 minutes
morning – 30 minutes afternoon); stress control (anxiety
over illness, finance, and human relationship).
 • What are tips on avoiding or reducing low-
Health Issue
value or unnecessary prescriptions of
Course–
medications?
Low-value
Medical Care: Illustration:
Prescription of
• Medications only as needed for moderate to severe
Medications symptoms (paracetamol for fever 39C and above and
severe body pain; no need for vitamins and
supplements; honey and lemon for cough and colds)
• Monitoring of Temperature, O2 Saturation (if there is a
pulse oximeter) and Respiratory Rate; and Symptoms (3x
a day until release from isolation day).
• Ready with hotlines for Oxygen and Hospitals (for
emergency use).
• Report to me every day up to release from isolation day.
 • What are tips on avoiding or reducing low-
Health Issue
value or unnecessary prescriptions of
Course–
medications?
Low-value
Medical Care: Illustration: Confining mild
Prescription of COVID19 patients
Medications • Rationale for ROJoson Management Regimen
with NO co-
of Mild COVID19 with NO Co-morbidity
• Home management is sufficient as 99% will morbidity to hospital
is NOT indicated. If
spontaneously recover with supportive
done, it is
management. What is needed though is
considered a low-
close monitoring at home.
• Hospital confinement is NOT indicated. value medical care –
unnecessary hospital
confinement.
 • What are tips on avoiding or reducing low- Outrightly
Health Issue
value or unnecessary prescriptions of prescribing
Course–
medications? medications for
Low-value
fever, cough and
Medical Care: Illustration: colds is considered a
Prescription of
• Rationale for ROJoson Management Regimen low-value medical
Medications
of Mild COVID19 with NO Co-morbidity care – unnecessary
• Medications only as needed for moderate prescriptions of
to severe symptoms (paracetamol for fever medications.
39C and above and severe body pain; no
need for vitamins and supplements; honey
and lemon for cough and colds)
 • What are tips on avoiding or reducing low- Outrightly
Health Issue
value or unnecessary prescriptions of prescribing
Course–
medications? medications for
Low-value
fever, cough and
Medical Care: Illustration: colds is considered a
Prescription of
• Rationale for ROJoson Management Regimen low-value medical
Medications
of Mild COVID19 with NO Co-morbidity care – unnecessary
• Prescribe medications only when needed prescriptions of
and NOT outright because in more than medications.
50% of the time, the symptoms of fever,
coughs and colds spontaneously resolve
with body resistance-immunity build-up and
maintenance.
 • What are tips on avoiding or reducing low- Outrightly
Health Issue
value or unnecessary prescriptions of prescribing vitamins
Course–
medications? and supplements is
Low-value
considered a low-
Medical Care: Illustration: value medical care –
Prescription of
• Rationale for ROJoson Management Regimen unnecessary
Medications
of Mild COVID19 with NO Co-morbidity prescriptions of
• Medications only as needed for moderate medications.
to severe symptoms (paracetamol for fever
39C and above and severe body pain; no
need for vitamins and supplements; honey
and lemon for cough and colds)
 • What are tips on avoiding or reducing low- Outrightly
Health Issue
value or unnecessary prescriptions of prescribing vitamins
Course–
medications? and supplements is
Low-value
considered a low-
Medical Care: Illustration:
value medical care –
Prescription of • Rationale for ROJoson Management Regimen unnecessary
Medications of Mild COVID19 with NO Co-morbidity prescriptions of
• There is no need for vitamins and medications.
supplements as long as the patient is
prescribed proper nutrition (balanced,
varied diet with plenty of vegetable and
fruits). Vitamins and supplements are not
indicated; may cause harms – side effects;
entail expense.
 • What are tips on avoiding or reducing low- There are so many
Health Issue
value or unnecessary prescriptions of drugs that can be
Course–
medications? used for high
Low-value
temperature – fever.
Medical Care: Illustration: ibuprofen, naproxen,
Prescription of ketoprofen, aspirin,
Medications • Rationale for ROJoson Management Regimen paracetamol, fenoprofen,
of Mild COVID19 with NO Co-morbidity flurbiprofen, oxaprozin,
• Medications only as needed for moderate indomethacin, sulindac,
tolmetin, etodolac,
to severe symptoms (paracetamol for fever diclofenac, lumiracoxib,
39C and above and severe body pain; no nabumetone, piroxicam,
meloxicam, mefenamic
need for vitamins and supplements; honey
acid, and meclofenamic
and lemon for cough and colds) acid
Which one is most cost-
effective?
 • What are tips on avoiding or reducing low- There are so many
Health Issue
value or unnecessary prescriptions of drugs that can be
Course–
medications? used for high
Low-value
temperature – fever.
Medical Care: Always use BRCA Process in selecting cost-
Prescription of effective medications for FEVER.
Medications
Options Benefit Risk Cost Availability
 Medications
Paracetamol  +  +  +  ++++
Ibuprofen  ++  +++  ++  ++
Aspirin  ++  ++++  +  +

Which one is the most cost-effective and readily

available? PARACETAMOL
 • What are tips on avoiding or reducing low- There are so many
Health Issue
value or unnecessary prescriptions of drugs that can be
Course–
medications? used for high
Low-value
temperature – fever.
Medical Care: Always use BRCA Process in selecting cost-
Prescription of effective medications for FEVER. Prescribing
Medications
Options Benefit Risk Cost Availability antipyretic with
 Medications higher risk for side
Paracetamol  +  +  +  ++++
effects is considered
Ibuprofen  ++  +++  ++  ++
Aspirin  ++  ++++  +  +
a low-value medical
care – unnecessary
Which one is the safest? PARACETAMOL prescriptions of
Ibuprofen – stomach upset; kidney risk; allergies medications.
Aspirin – thinning of blood; stomach upset
 • What are tips on avoiding or reducing low- There are so many
Health Issue
value or unnecessary prescriptions of drugs that can be
Course–
medications? used for high
Low-value
temperature – fever.
Medical Care: Always use BRCA Process in selecting cost-
Prescription of effective medications for FEVER. Prescribing costlier
Medications
Options Benefit Risk Cost Availability antipyretic is
 Medications considered a low-
Paracetamol  +  +  +  ++++
value medical care –
Ibuprofen  ++  +++  ++  ++
Aspirin  ++  ++++  +  +
unnecessary
prescriptions of
Which one is the most costly? IBUPROFEN medications.
 • What are tips on avoiding or reducing low- There are so many
Health Issue
value or unnecessary prescriptions of drugs that can be
Course–
medications? used for body pain.
Low-value
Medical Care: *If pain is not relieved
Always use BRCA Process in selecting cost-
Prescription of by paracetamol,
effective medications for BODY PAIN (severe)
Medications ibuprofen can next be
Options Benefit Risk Cost Availability
prescribed.
 Medications
Paracetamol  +  +  +  ++++
Ibuprofen  ++  +++  ++  ++
Aspirin  ++  ++++  +  +

Which one is the most cost-effective and readily

available for? PARACETAMOL
 • What are tips on avoiding or reducing low- Prescribing
Health Issue
value or unnecessary prescriptions of medications against
Course–
medications? cough and colds
Low-value
without trying
Medical Care: Illustration: simple home remedy
Prescription of
• Rationale for ROJoson Management Regimen is considered a low-
Medications
of Mild COVID19 with NO Co-morbidity value medical care –
• Medications only as needed for moderate unnecessary
to severe symptoms (paracetamol for fever prescriptions of
39C and above and severe body pain; no medications.
need for vitamins and supplements; honey
and lemon for cough and colds)
 • What are tips on avoiding or reducing low-
Health Issue
value or unnecessary prescriptions of
Course–
medications?
Low-value
Medical Care: Always use BRCA Process in selecting cost-
Prescription of effective medications for COUGH.
Medications
Options Benefit Risk Cost Availability
 Medications
Honey - Lemon  ++  +  +  ++++
Cough medicine  +  +++  +++  +++

Which one is the most cost-effective and readily

available? Honey-Lemon
 • What are tips on avoiding or reducing low-
Health Issue
value or unnecessary prescriptions of
Course–
medications?
Low-value
Medical Care: Always use BRCA Process in selecting cost-
Prescription of effective medications for COLDS.
Medications
Options Benefit Risk Cost Availability
 Medications
Honey - Lemon  ++  +  +  ++++
Cough medicine  +  +++  +++  +++

Which one is the most cost-effective and readily

available? Honey-Lemon
 • What are tips on avoiding or reducing low- Prescribing an
Health Issue
value or unnecessary prescriptions of antibiotics for a viral
Course–
medications? indication such as
Low-value
COVID19 is not
Medical Care: Illustration: indicated. It is
Prescription of
• Rationale for ROJoson Management Regimen considered a low-
Medications
of Mild COVID19 with NO Co-morbidity value medical care –
• Dr. Rey did not prescribe antibiotics. unnecessary
Azithromycin is a common antibiotic prescriptions of
prescribed by a lot of physicians during the medications.
COVID19 pandemic.
 • What are tips on avoiding or reducing low- Prescribing ANTIBIOTICS
Health Issue for a viral infection is
value or unnecessary prescriptions of
Course– INAPPROPRIATE (thus,
medications?
Low-value low-value prescription of
Medical Care: medications).
Illustration: Possible causes:
Prescription of - Ignorance of
Medications • Rationale for ROJoson Management Regimen
physician
of Mild COVID19 with NO Co-morbidity - Physician satisfying
• Dr. Rey did not prescribe antibiotics. patient because of
Azithromycin is a common antibiotic mindset and desire
prescribed by a lot of physicians during the - Physician’s ulterior
COVID19 pandemic. motive of financial
gain (incentivized or
personal basis)
 • What are tips on avoiding or reducing low-
Health Issue
value or unnecessary prescriptions of
Course–
medications?
Low-value
Medical Care:
Prescription of Some more recommendations.
Medications
 • What are tips on avoiding or reducing low- Patients do not
Health Issue
value or unnecessary prescriptions of know whether there
Course–
medications? are ulterior motives
Low-value
The best diplomatic strategy to prevent this ulterior motive behind physicians’
Medical Care:
is to ask the physicians to present and discuss the prescriptions of
Prescription of
comparative data and information on the benefit, risk, cost medications such as
Medications and availability of the different options of medications. incentivization and
Analyze them and then make a judgement on physician’s
personal business
competency and presence of ulterior motives.
sense.
Options Benefit Risk Cost Availability
 Medications
       
       
       
 • What are tips on avoiding or reducing low- Commendable
Health Issue
value or unnecessary prescriptions of physician’s attitude
Course–
medications? that will prevent
Low-value
low-value
Medical Care: “I’m not going to prescribe a low-value
prescriptions of
Prescription of medication just because a patient has requested
medications just
Medications it. I just think that we need to talk more about it
because of wanting
so we can get on the same page.”
to satisfy mindsets
“But when I feel strongly that something… has
and desires of
harms then I guess I am less likely to take the
patients.
patient preference.”
“…the patient really shouldn’t force your pen to
the prescribing pad.”
 • What are tips on avoiding or reducing low- Commendable
Health Issue
value or unnecessary prescriptions of physician’s attitude
Course–
medications? that will prevent
Low-value
low-value
Medical Care: “I am sorry your perception on medications for
prescriptions of
Prescription of this medical condition are myths, incorrect and
medications just
Medications unfounded. I have to correct you on this through
because of wanting
these explanations.”
to satisfy mindsets
and desires of
“I am sorry we have to decide on what type of
patients.
medications to take based on hard evidences and
not based on fad and popular practices.”
 • What are tips on avoiding or reducing low-
Health Issue
value or unnecessary prescriptions of
Course–
medications?
Low-value
Medical Care:
Prescription of
Medications
 Contents of PEP TALK on Low-value Medical Care: Summary
Health Issue
Prescription of Medications Take Away
Course–
• What is a low-value medical care?
Low-value • What are the different types of low-value medical
Medical Care: care?
Prescription of • What are the causes of low-value medical care?
Medications • How common are the low-value medical care?
• What is low-value prescription of medications?
• What are examples of low-value or unnecessary
prescription of medications?
• What are the causes and types of low-value or
unnecessary prescription of medications?
• What are tips on avoiding or reducing low-value or
unnecessary prescription of medications?
 Health Issue
Be always in touch with reliable medical Take Away in
information on low-value (unnecessary) and high- relation to
Course–
value (highly recommended) medical care.
Low-value Patient
Medical Care: Empowerment
Prescription of Knowledge is power; it gives power.
Medications Use the 4Ks of Patient Empowerment:
Kaalaman, Kakayanan, Karapatan and
Kapangyarihan
to gain greater control over decisions in
medical management of oneself in
promoting high-value medical care and
avoiding low-value medical care.
 Empowerment
objective - for
laypeople to have an
Health Issue understanding of the
Course– importance of Low-
Low-value value Medical Care:
Medical Care: (Unnecessary)
Prescription of Prescription of
Medications Medications in the
management of
their health.