Perceived Barriers to Implementing Individual Choosing Wisely® Recommendations in Two National Surveys of Primary Care Providers

Abstract

BackgroundWhile some research has examined general attitudes about efforts to reduce overutilization of services, such as the Choosing Wisely® (CW) initiative, little data exists regarding primary care providers’ attitudes regarding individual recommendations.ObjectiveWe sought to identify whether particular CW recommendations were perceived by primary care providers as difficult to follow, difficult for patients to accept, or both.DesignTwo national surveys, one by mail to a random sample of 2000 U.S. primary care physicians in November 2013, and the second electronically to a random sample of 2500 VA primary care providers (PCPs) in October–December 2014.ParticipantsA total of 603 U.S. primary care physicians and 1173 VA primary care providers. Response rates were 34 and 48 %, respectively.Main MeasuresPCP ratings of whether 12 CW recommendations for screening, testing and treatments applicable to adult primary care were difficult to follow and difficult for patients to accept; and ratings of potential barriers to reducing overutilization.Key ResultsFor four recommendations regarding not screening or testing in asymptomatic patients, less than 20 % of PCPs found the CW recommendations difficult to accept (range 7.2–16.6 %) or difficult for patients to follow (12.2–19.3 %). For five recommendations regarding testing or treatment for symptomatic conditions, however, there was both variation in reported difficulty to follow (9.8–32 %) and a high level of reported difficulty for patients to accept (35.7–87.1 %). The most frequently reported barriers to reducing overuse included malpractice concern, patient requests for services, lack of time for shared decision making, and the number of tests recommended by specialists.ConclusionsWhile PCPs found many CW recommendations easy to follow, they felt that some, especially those for symptomatic conditions, would be difficult for patients to accept. Overcoming PCPs’ perceptions of patient acceptability will require approaches beyond routine physician education, feedback and financial incentives.

Improving quality in the preanalytical phase through innovation, on behalf of the European Federation for Clinical Chemistry and Laboratory Medicine (EFLM) Working Group for Preanalytical Phase (WG-PRE)

“…While the initiative has not gone without criticism, i.e. not all recommendations have been developed with standardized methodology or undisputed evidence [43], and other recommendations are perceived as difficult to implement [44], the initiative still represents an important attempt to reduce overutilization of medical interventions, including laboratory testing, that are not expected to be beneficial for the patients.…”

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

“…1 The investigators describe survey findings from 34 % of 2000 internal medicine, family medicine, and geriatrics physicians contacted through a nationally representative random sample and 48 % of 2500 representative primary care clinicians (physicians, nurse practitioners, and physician assistants) practicing in Department of Veterans Affairs (VA) facilities. Despite the differences in the two surveyed clinician populations, and in their practice settings, the different respondents noted remarkably consistent concerns regarding the feasibility of following these CW recommendations in their setting.…”

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

“…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.…”