Improving Clinical Appropriateness Across Borders: Essencial in the CIRCE Joint Action

Abstract Background Essencial initiative (Catalonia, Spain) was selected by the European Commission as a Best Practice (BP) within the CIRCE Joint Action, which aims to strengthen primary care (PC) across member states. Essencial seeks to reduce low-value clinical practices (LVCP) through evidence-based recommendations, promoting quality, safety, sustainability, and thereby quaternary prevention. The BP was selected for transfer by three implementers (IP): a Croatian public health agency, a Polish public health insurer, and a Greek primary care team. Methods A structured, contextualized knowledge transfer process was provided to IP, including training on the de-implementation guide, asynchronous educational materials, and in-person visits. BP owners shared clinical indicators and a repository of professional and patient resources. Each IP developed an implementation plan targeting a specific LVCP, launching 6-9-month pilots (until August 2025). Two IP address antibiotic overuse in paediatrics; one aims to reduce reducing proton pump inhibitor (PPI) in older adults. Evaluation follows RE-AIM and Proctor frameworks. Results Two IP collected antibiotic consumption data for the first time. Croatia and Poland had difficulties engaging healthcare professionals (HCP). Actions to mitigate were: Croatia allied with Society of Preventive Paediatrics, Poland signed a contract with 2 providers and designed visual materials for patients. Greece has already stopped PPI in 23 elderly (20% of patients offered) and trained community pharmacists. Conclusions Transferring the Essencial BP across different health systems contributes to better clinical alignment with guidelines, improved patient safety, and more efficient PC. Despite contextual challenges, the targeted LVCP strengthen HCP engagement and establish a foundation for sustainable, system-wide improvements. The position of each IP within its national health system significantly influences the impact and sustainability of the intervention. Key messages • Transferring a stepped process to reduce harm associated with unnecessary healthcare across different European contexts is feasible, promotes safety and equality. • Across Europe, there are similar health concerns that can be approached through a joint action.