Alihoito

Alihoito, in Finnish healthcare, denotes undertreatment: when patients with a diagnosed condition receive less intensive or less appropriate care than guidelines or patient needs would justify. It can involve medications, diagnostic workups, procedures, preventive measures, and symptom relief. Undertreatment is distinct from non-treatment and from overtreatment, and it is discussed as a factor that can worsen outcomes in many diseases.

Causes are multifactorial. Patient factors include frailty, age, comorbidity, treatment preferences, and fear of side effects. Provider factors include guideline familiarity, risk aversion, time constraints, implicit biases, and concerns about polypharmacy. System factors include access barriers, cost, formulary restrictions, and care fragmentation. Undertreatment can vary across patient groups, contributing to inequities in care.

Consequences include poorer disease control, higher symptom burden, reduced quality of life, and higher rates of hospitalization and mortality in some settings. Examples reported in research include underuse of evidence-based therapies in older patients with cardiovascular disease, inadequate pain management in cancer, and insufficient preventive care in chronic illnesses.

Assessment relies on comparing actual care with guideline-based recommendations and population benchmarks. Addressing alihoito involves promoting guideline adherence, shared decision-making, individualized treatment planning, frailty-aware risk assessments, and interventions to improve access and reduce disparities.