undertreatment

Undertreatment refers to the failure to provide or administer medical treatment that is indicated or appropriate for a patient's condition, resulting in suboptimal health outcomes. It can involve insufficient dosing, incomplete or shortened treatment courses, delayed initiation of therapy, or the omission of recommended preventive or therapeutic interventions. Undertreatment is distinct from overtreatment, which involves excessive or unnecessary care.

Contributing factors are diverse and may be patient-related, clinician-related, or systemic. Patient factors include access barriers, financial constraints, health literacy, and adherence challenges. Clinician factors encompass uncertainty about benefits or harms, bias, risk aversion, and inconsistent application of guidelines. Systemic contributors include resource limitations, fragmented care, time pressures, gaps in guideline dissemination, and inequities in healthcare delivery.

Examples occur across medical domains. In pain management, patients may receive inadequate analgesia. In chronic diseases, antihypertensive or lipid-lowering therapies may not be intensified or initiated when indicated. In infectious disease, antibiotics may be prescribed for too short a duration or not started when appropriate. In cancer care, treatment may be withheld or deferred due to age, frailty, or comorbidities, even when potential benefits exist. Preventive services, such as vaccinations or screening and early intervention, may also be underutilized.

Implications of undertreatment include persistent symptoms, disease progression, higher morbidity, reduced quality of life, and greater long-term costs. Ethically, undertreatment raises concerns about equity and justice in access to effective care.

Mitigation strategies focus on adherence to evidence-based guidelines, regular treatment reviews, shared decision-making, improving access and care coordination, addressing biases, and ongoing quality improvement to monitor and reduce undertreatment.