Primary Care Physician Perspectives about Antipsychotics and Other Medications for Symptoms of Dementia

Kerns, J. William; Winter, Jonathan D.; Winter, Katherine; Boyd, Terry; Etz, Rebecca

doi:10.3122/jabfm.2018.01.170230

Cited by 36 publications

(38 citation statements)

References 41 publications

(51 reference statements)

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“…The process of keeping updated on the latest guidelines is time-consuming, and there seems to be a lack of prompts for what guideline to examine and when. As a reason, uncertainty and disagreement about what not to do resonates with previous research pointing to numerous barriers to guideline use, including con icting recommendations in guidelines (40), nonapplicable guidelines (41), and clinicians not being convinced of a practice being LVC (42). This is in line with previous implementation research stating that knowledge is not enough to succeed with change (43).…”

Section: Discussionsupporting

confidence: 82%

Why Do They Do It? A Grounded Theory Study of the Use of Low-value Care Among Primary Health Care Physicians

Ingvarsson

Augustsson

Hasson

et al. 2020

Preprint

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Background The use of low-value care (LVC) is widespread and has an impact on both the use of resources and quality of care. However, few studies have thus far studied the factors influencing the use of LVC from the perspective of the practitioners themselves. The aim of this study is to understand why physicians within primary care use LVC. Methods Six primary health care centers in the Stockholm Region were purposively selected based on their level of prescription of three low-value lab tests (e.g., erythrocyte sedimentation rate, aspartate transaminase, vitamin D). FGDs were conducted with physicians (n = 31) working in the centers. The discussions were coded inductively using a grounded theory approach. Results Three main reasons for performing LVC were identified. Uncertainty and disagreement about what not to do was related to being unaware of the LVC status of a practice, guidelines perceived as conflicting, guidelines perceived to be irrelevant for the target patient population, or a lack of trust in the guidelines. Perceived pressure from others concerned patient pressure, pressure from other physicians, or pressure from the health care system. A desire to do something for the patients was associated with the fact that the visit in itself prompts action, symptoms to relieve, or emotions to calm. The three reasons are interdependent. Uncertainty and disagreement about what not to do have made it more difficult to handle the pressure from others and to refrain from doing something for the patients. The pressure from others and the desire to do something for the patients enhanced the uncertainty and disagreement about what not to do. Furthermore, the pressure from others influenced the desire to do something for the patients. Conclusions Three reasons work together to explain primary care physicians’ use of LVC: uncertainty and disagreement about what not to do, perceived pressure from others, and the desire to do something for the patients. The reasons may, in turn, be influenced by the health care system, but the decision nevertheless seemed to be up to the individual physician. The findings suggest that the de-implementation of LVC needs to address the three reasons from a systems perspective.

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Section: Discussionsupporting

confidence: 82%

Why Do They Do It? A Grounded Theory Study of the Use of Low-value Care Among Primary Health Care Physicians

Ingvarsson

Augustsson

Hasson

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…The process of keeping updated on the latest guidelines is time-consuming, and there seems to be a lack of prompts for what guidelines to examine and when. As a reason, uncertainty and disagreement about what not to do resonate with previous research pointing to numerous barriers to guideline use, including conflicting recommendations in guidelines [30], nonapplicable guidelines [31], and clinicians not being convinced of a practice being LVC [32]. This is in line with previous implementation research stating that knowledge is not enough to succeed with change [33].…”

Section: Discussionsupporting

confidence: 81%

Why do they do it? A grounded theory study of the use of low-value care among primary health care physicians

et al. 2020

View full text Add to dashboard Cite

Background The use of low-value care (LVC) is widespread and has an impact on both the use of resources and the quality of care. However, few studies have thus far studied the factors influencing the use of LVC from the perspective of the practitioners themselves. The aim of this study is to understand why physicians within primary care use LVC. Methods Six primary health care centers in the Stockholm Region were purposively selected. Focus group discussions were conducted with physicians (n = 31) working in the centers. The discussions were coded inductively using a grounded theory approach. Results Three main reasons for performing LVC were identified. Uncertainty and disagreement about what not to do was related to being unaware of the LVC status of a practice, guidelines perceived as conflicting, guidelines perceived to be irrelevant for the target patient population, or a lack of trust in the guidelines. Perceived pressure from others concerned patient pressure, pressure from other physicians, or pressure from the health care system. A desire to do something for the patients was associated with the fact that the visit in itself prompts action, symptoms to relieve, or that patients' emotions need to be reassured. The three reasons are interdependent. Uncertainty and disagreement about what not to do have made it more difficult to handle the pressure from others and to refrain from doing something for the patients. The pressure from others and the desire to do something for the patients enhanced the uncertainty and disagreement about what not to do. Furthermore, the pressure from others influenced the desire to do something for the patients. Conclusions Three reasons work together to explain primary care physicians’ use of LVC: uncertainty and disagreement about what not to do, perceived pressure from others, and the desire to do something for the patients. The reasons may, in turn, be influenced by the health care system, but the decision nevertheless seemed to be up to the individual physician. The findings suggest that the de-implementation of LVC needs to address the three reasons from a systems perspective.

show abstract

“…The process of keeping updated on the latest guidelines is time-consuming, and there seems to be a lack of prompts for what guideline to examine and when. As a reason, uncertainty and disagreement about what not to do resonates with previous research pointing to numerous barriers to guideline use, including con icting recommendations in guidelines (30), non-applicable guidelines (31), and clinicians not being convinced of a practice being LVC (32). This is in line with previous implementation research stating that knowledge is not enough to succeed with change (33).…”

Section: Discussionsupporting

confidence: 82%

Why do they do it? A grounded theory study of the use of low-value care among primary health care physicians

Ingvarsson

Augustsson

Hasson

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: The use of low-value care (LVC) is widespread and has an impact on both the use of resources and quality of care. However, few studies have thus far studied the factors influencing the use of LVC from the perspective of the practitioners themselves. The aim of this study is to understand why physicians within primary care use LVC. Methods: Six primary health care centers in the Stockholm Region were purposively selected. Focus group discussions were conducted with physicians (n = 31) working in the centers. The discussions were coded inductively using a grounded theory approach. Results: Three main reasons for performing LVC were identified. Uncertainty and disagreement about what not to do was related to being unaware of the LVC status of a practice, guidelines perceived as conflicting, guidelines perceived to be irrelevant for the target patient population, or a lack of trust in the guidelines. Perceived pressure from others concerned patient pressure, pressure from other physicians, or pressure from the health care system. A desire to do something for the patients was associated with the fact that the visit in itself prompts action, symptoms to relieve, or emotions to calm. The three reasons are interdependent. Uncertainty and disagreement about what not to do have made it more difficult to handle the pressure from others and to refrain from doing something for the patients. The pressure from others and the desire to do something for the patients enhanced the uncertainty and disagreement about what not to do. Furthermore, the pressure from others influenced the desire to do something for the patients. Conclusions: Three reasons work together to explain primary care physicians’ use of LVC: uncertainty and disagreement about what not to do, perceived pressure from others, and the desire to do something for the patients. The reasons may, in turn, be influenced by the health care system, but the decision nevertheless seemed to be up to the individual physician. The findings suggest that the de-implementation of LVC needs to address the three reasons from a systems perspective.

show abstract

Primary Care Physician Perspectives about Antipsychotics and Other Medications for Symptoms of Dementia

Cited by 36 publications

References 41 publications

Why Do They Do It? A Grounded Theory Study of the Use of Low-value Care Among Primary Health Care Physicians

Why Do They Do It? A Grounded Theory Study of the Use of Low-value Care Among Primary Health Care Physicians

Why do they do it? A grounded theory study of the use of low-value care among primary health care physicians

Why do they do it? A grounded theory study of the use of low-value care among primary health care physicians

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