Primary Care Clinicians’ Perspectives on Reducing Low-Value Care in an Integrated Delivery System

Buist, Diana S.M.; Chang, Eva; Handley, Matt; Pardee, Roy; Gundersen, Gabrielle; Cheadle, Allen; Reid, Robert J.

doi:10.7812/tpp/15-086

Cited by 43 publications

(56 citation statements)

References 6 publications

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“…Consistent with other studies, main drivers of overuse were seen in factors outside GPs own responsibility [35,36,50]. It is known that attributing causes for failures or negative events to others helps in self-serving but is likely to prevent self-responsibility and behavior change [51].…”

Section: A General Assessment Of Medical Overusesupporting

confidence: 80%

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Is it really always only the others who are to blame? GP’s view on medical overuse. A questionnaire study

et al. 2020

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Section: A General Assessment Of Medical Overusesupporting

confidence: 80%

“…The limited awareness of GPs for campaigns against medical overuse is not unusual [50,52]. In our study, campaign interested GPs represented a more critical point of view with higher awareness of medical overuse.…”

Section: A General Assessment Of Medical Overusementioning

confidence: 58%

Is it really always only the others who are to blame? GP’s view on medical overuse. A questionnaire study

et al. 2020

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“…In a recent online survey of 304 Group Health primary care providers, two thirds of respondents regarded themselves as aware of the Choosing Wisely campaign, whereas only one-third were unaware. 15 Practicerelated characteristics and group normative behaviors may also stimulate interest in and awareness of addressing unnecessary care in general and of Choosing Wisely in particular.…”

Section: Discussionmentioning

confidence: 99%

“…Buist et al 15 found that time constraints and challenges posted by overcoming the expectations and values of patients were top areas of concern for participants in their integrated delivery system practice. Our work is, to our knowledge, the first to assess specific barriers for each service from the "list of 5" individually.…”

Section: Barriers To Guideline-concordant Carementioning

confidence: 99%

Physician Cost Consciousness and Use of Low-Value Clinical Services

Grover

Abraham

Chang

et al. 2016

The Journal of the American Board of Family Medicine

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Purpose: Choosing Wisely TM engaged medical specialties, creating "top 5 lists" of low-value services. We describe primary care physicians' (PCPs') self-reported use of these services and perceived barriers to guideline adherence. We quantify physician cost consciousness and determine associations with use.Methods: PCP attendees of a continuing medical education conference completed a survey. For each Family Medicine Choosing Wisely behavior, participants reported clinical adherence. Likert scale items assessed perceived barriers. Low-value service frequency was the dependent variable. A validated Cost Consciousness Scale created the predictor variable. We hypothesized that participants with greater cost consciousness would report less frequent use of low-value services.Results: Of 199 PCP attendees, 143 (72%) participated. Papanicolaou test after hysterectomy was performed least (0.2 mean services performed/10 patients). Provider knowledge of sinusitis treatment guidelines was greatest but provided most frequently (3.9 mean services performed/10 patients). Practice related barriers were perceived most frequently for adhering to sinusitis treatment guidelines. Attitudinal barriers were greatest for avoiding osteoporosis screening in low risk patients. Greater cost consciousness was associated with less use of low-value services (P ‫؍‬ .03), greater knowledge of guidelines (P ‫؍‬ .001), and fewer perceived attitudinal and practice behavior-related barriers (P < .001 for each). Greater knowledge of guidelines was not associated with less use of low-value services (P ‫؍‬ .58). Familiarity with Choosing Wisely was associated with both greater cost consciousness (P ‫؍‬ .004) and less use of low-value services (P ‫؍‬ .03).Conclusions: Greater PCP cost consciousness was associated with less use of low-value services. Interventions to decrease perceived barriers and increase cost consciousness, perhaps by increasing awareness of Choosing Wisely, may translate into improved performance.

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“…Algunos factores específicos del proveedor pueden obstaculizar los esfuerzos para reducir el uso excesivo 15 . Entre los médicos, por ejemplo, la falta de acuerdo con recomendaciones específicas, la preocupación sobre la mala praxis, la falta de tiempo para hablar con los pacientes 16 y el deseo de mantener a los pacientes satisfechos 17 pueden plantear barreras para reducir el uso de algunos servicios 18,19 . Dado que estas iniciativas son recientes, existe poca información sobre su impacto.…”

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