“…The questionnaire used was based on the one designed by the research group SOBRINA for a homologous study previously carried out with the participation of primary care professionals [24][25][26]. The group of researchers in this study reviewed the questions and adapted them to the context and clinical reality of surgeons and anesthetists, verifying the degree of understanding of the questions.…”
OBJECTIVES: To know the frequency and causes of low value surgical practices, according to the opinion of surgeons and anesthetists, and to determine their degree of knowledge about the Spanish “Choosing wisely” initiative. METHODS: Cross-sectional observational study, based on a self-administered online questionnaire through an opportunistic sample of 370 surgeons and anesthetists from three Spanish regions, contacted through Scientific Societies. The survey took part between July and December 2017. RESULTS: A patient profile requesting unnecessary practices was identified (female, 51−65 years old and unaffiliated disease). The frequency of requests was weekly or daily for 50.0% of the professionals, of whom 15.1% acknowledged succumbing to these pressures. To dissuade the patient, clinical reasons (47%) were considered the most effective. To increase control and safety in the case was the main reason to indicate them. The greatest responsibility for overuse was attributed to physicians, defensive medicine and mass media. Assessing professionals’ knowledge on unnecessary practices, an average of 5 correct answers out of 7 was obtained. Some 64.1% of the respondents were unaware of the Spanish “Choosing wisely” initiative. CONCLUSIONS: Low value surgical practices are perceived as a frequent problem, which requires an approach entailing intervention with patients and the media as well as professionals. Increase awareness on unnecessary surgical practices, and how to avoid them remain essential.
“…The questionnaire used was based on the one designed by the research group SOBRINA for a homologous study previously carried out with the participation of primary care professionals [24][25][26]. The group of researchers in this study reviewed the questions and adapted them to the context and clinical reality of surgeons and anesthetists, verifying the degree of understanding of the questions.…”
OBJECTIVES: To know the frequency and causes of low value surgical practices, according to the opinion of surgeons and anesthetists, and to determine their degree of knowledge about the Spanish “Choosing wisely” initiative. METHODS: Cross-sectional observational study, based on a self-administered online questionnaire through an opportunistic sample of 370 surgeons and anesthetists from three Spanish regions, contacted through Scientific Societies. The survey took part between July and December 2017. RESULTS: A patient profile requesting unnecessary practices was identified (female, 51−65 years old and unaffiliated disease). The frequency of requests was weekly or daily for 50.0% of the professionals, of whom 15.1% acknowledged succumbing to these pressures. To dissuade the patient, clinical reasons (47%) were considered the most effective. To increase control and safety in the case was the main reason to indicate them. The greatest responsibility for overuse was attributed to physicians, defensive medicine and mass media. Assessing professionals’ knowledge on unnecessary practices, an average of 5 correct answers out of 7 was obtained. Some 64.1% of the respondents were unaware of the Spanish “Choosing wisely” initiative. CONCLUSIONS: Low value surgical practices are perceived as a frequent problem, which requires an approach entailing intervention with patients and the media as well as professionals. Increase awareness on unnecessary surgical practices, and how to avoid them remain essential.
“…These triggers were designed specifically for this study, involving 25 primary care professionals in a previous study. 23 These physicians were asked what AAEs could be caused when the DNDs included in this study were ignored. They also suggested potential drivers for each AAE (e.g., referral for psychotherapy for benzodiazepine abuse, early onset of withdrawal or hospital admission for a fall, admission to the intensive care unit).…”
Section: Methodsmentioning
confidence: 99%
“…Ten DNDs fulfilling criteria were chosen (Box 1). 23 Box 1 Do-not-do recommendations included in this study.…”
“…To determine the overuse related to DNDs, seven DNDs from medicine and three from paediatrics, that fulfil the criteria of presenting relatively frequently in practice, can be reliably identified and can also be the cause of an AE, have been chosen based on the prioritisation recommended in a previous study using the Delphi technique with 100 healthcare professionals (box 1). 33 Do-not-do recommendations selected for analysis of the present study
Medicine
Prescribe benzodiazepines to treat insomnia, agitation or delirium in people older than 65 years.Prescribe non-steroidal anti-inflammatory drugs for patients with cardiovascular disease, chronic kidney disease, hypertension, heart failure or liver cirrhosis.Recommend taking a dose of 1 g of paracetamol for more than 3 days.Order antibiotic treatment for acute bronchitis when the patient does not suffer from chronic obstructive pulmonary disease, heart failure, diabetes or kidney disease, or undergoing active chemotherapy.Prescribe lipid-lowering drugs in patients older than 75 years without previous cardiovascular events.Perform prostate cancer screening in asymptomatic patients.Order image tests in nonspecific lumbago.
Paediatrics
Prescribe antibiotics for infants with pharyngitis.Prescribe mucolytic drugs, antitussives or antibiotics for upper respiratory infections in infants.Combine treatment between ibuprofen and paracetamol in infants.
…”
Section: Methods and Analysismentioning
confidence: 99%
“…To determine the overuse related to DNDs, seven DNDs from medicine and three from paediatrics, that fulfil the criteria of presenting relatively frequently in practice, can be reliably identified and can also be the cause of an AE, have been chosen based on the prioritisation recommended in a previous study using the Delphi technique with 100 healthcare professionals ( box 1 ). 33 Do-not-do recommendations selected for analysis of the present study
Medicine
Prescribe benzodiazepines to treat insomnia, agitation or delirium in people older than 65 years. Prescribe non-steroidal anti-inflammatory drugs for patients with cardiovascular disease, chronic kidney disease, hypertension, heart failure or liver cirrhosis.
Introduction
Several institutions and quality national agencies have fostered the
creation of recommendations on what not to do to reduce overuse in
clinical practice. In primary care, their impact has hardly been
studied. The frequency of adverse events (AEs) associated with doing
what must not be done has not been analysed, either. The aim of this
study is to measure the frequency of overuse and AEs associated with
doing what must not be done (commission errors) in primary care and
their cost.
Methods and analysis
A coordinated, multicentric, national project. A retrospective
cohort study using computerised databases of primary care medical
records from national agencies and regional health services will be
conducted to analyse the frequency of the overuse due to ignore the
do-not-do recommendations, and immediately afterwards, depending on
their frequency, a representative random sample of medical records will
be reviewed with algorithms (triggers) that determine the frequency of
AEs associated with these recommendations. Cost will determine by
summation of the direct costs due to the consultation, pharmacy,
laboratory and imaging activities according to the cases.
Ethics and dissemination
The study protocol has been approved by the Ethics Committee of
Primary Care Research of the Valencian Community. We aim to disseminate
the findings through international peer-reviewed journals and on the
website (http://www.nohacer.es/).Outcomes will be used to
incorporate algorithms into the electronic history to assist in making
clinical decisions.
Trial registration number
NCT03482232; Pre-results.
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