Barriers to Choosing Wisely® in Primary Care: It’s Not Just About “the Money”

Rich, Eugene C.

doi:10.1007/s11606-016-3916-7

Cited by 5 publications

(3 citation statements)

References 6 publications

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“…While educational efforts, such as the Choosing Wisely campaign, are important for raising awareness of the problem among clinicians and patients, additional efforts will be needed to significantly curb low-value care use and spending in light of our findings. 54 , 55 Specifically, we found that increases in the price of services, such as certain diagnostic imaging tests and invasive procedures (eg, PICCs), were also associated with increases in low-value care spending, and addressing price increases may represent an important strategy in reducing wasteful spending. 38 In terms of use, capitated payment models and accountable care organizations (ACOs) comprise an important strategy that may incentivize clinicians to reduce low-value care use across a broad range of clinical arenas.…”

Section: Discussionmentioning

confidence: 92%

“…To be sure, while increasing antibiotic and opioid prescriptions was associated with the increase in prescription drug use, the overall prescription drug spending decrease was partly associated with decreases in spending on nonsteroidal anti-inflammatory drugs, potentially associated in part with Celebrex (celecoxib) becoming generic in mid-2014. Nevertheless, in the midst of ongoing antibiotic overuse and an opioid overdose crisis, 43,53 professional medical record review. Fifth, the diagnosis code transition from ICD-9-CM to ICD-10-CM may be associated with biases in our results.…”

Section: Discussionmentioning

confidence: 99%

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Trends in Low-Value Health Service Use and Spending in the US Medicare Fee-for-Service Program, 2014-2018

et al. 2021

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Trends in Low-Value Health Service Use and Spending in the US Medicare Fee-for-Service Program, 2014-2018

et al. 2021

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“…18,19 Decisions to prescribe are not simply a matter of knowing the indications for drugs. Decisions are influenced by characteristics of patients 20 and practitioners, [21][22][23][24] the organizational settings in which physicians work, 25,26 commercial influences 23,27 and interactions among these factors. Continuing professional development is a means of influencing prescribing behaviour, but this calls for a clear understanding of the complex web of factors that cause questionable behaviours to exist and persist.…”

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confidence: 99%

The lesser of two evils: a qualitative study of quetiapine prescribing by family physicians

Kelly

Dornan

Pringsheim

2018

cmajo

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Global antipsychotic sales in 2010 were US$25.4 billion; of these, Seroquel (quetiapine) was the fifth highest selling pharmaceutical worldwide, costing an estimated US$6.8 billion. 4 In Canada, prescriptions for quetiapine rose by 300% between 2005 and 2012. Using the IMS Brogan Canadian CompuScript databases to identify prescribing data, researchers found that 50% of filled antipsychotic prescriptions in Canada were for quetiapine, and most came from family physicians.2 Although quetiapine is licensed for the treatment of schizophrenia and bipolar disorder and as an adjunctive to antidepressants in moderate to severe depression, much prescribing of quetiapine is offlabel.2,5 Off-label prescribing of antipsychotics has been studied extensively, including a meta-analysis of 170 studies. 6Leslie and colleagues 7 examined prescribing data from the US Department of Veteran Affairs and found that 60.2% of the 279 778 patients who received a prescription for an antipsychotic in 2007 had no indication for its licensed use; of these, 43% were prescribed quetiapine. More recently, researchers in the United Kingdom examined prescribing data using The Health Improvement Network, a primary care database of almost 10 million patients. 5 They found that only 36% (n = 4824) of those prescribed quetiapine had a serious mental illness recorded. Insomnia, anxiety and behavioural disturbance in elderly people and children are common reasons for off-label use. 3,6,8 Evidence of benefit for these indications is disputed. 6,9,10 Adverse metabolic, neurologic and cardiovascular effects 9,11 pose a significant risk of harm.11,12 Maglione and colleagues 6 calculated a number needed to harm of 8 (odds ratio 5.16, 95% confidence interval 2.93-9.51) for neurologic adverse effects in patients with dementia and of 16 (odds ratio 2.72, 95% confidence interval 2.07-3.56) for weight gain and increased appetite in other conditions. Background: Quetiapine is an antipsychotic that is widely prescribed off-label by family physicians despite evidence that safer alternatives exist. The aim of this research was to explore, in-depth, family physicians' reasons for this behaviour.

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