Watchful Waiting Strategy May Reduce Low-Value Diagnostic Testing

May, Larissa; Franks, Peter; Jerant, Anthony F; Fenton, Joshua J.

doi:10.3122/jabfm.2016.06.160056

Cited by 15 publications

(16 citation statements)

References 26 publications

(23 reference statements)

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“…7 In an observational analysis, we found that a clinician offer of a watchful waiting option was associated with less lowvalue test ordering, w ith no dec rement in patient satisfaction. 52 However, few randomized clinical trials of watchful waiting have been conducted, and none have examined the effectiveness of the approach, specifically in responding to patient requests in primary care or the resulting impact on satisfaction, underscoring the need for work in this realm. [53][54][55]…”

Section: Discussionmentioning

confidence: 99%

Association of Clinician Denial of Patient Requests With Patient Satisfaction

et al. 2018

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Prior studies suggesting clinician fulfillment or denial of requests affects patient satisfaction included limited adjustment for patient confounders. The studies also did not examine distinct request types, yet patient expectations and clinician fulfillment or denial might vary among request types. OBJECTIVE To examine how patient satisfaction with the clinician is associated with clinician denial of distinct types of patient requests, adjusting for patient characteristics. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional observational study of 1319 outpatient visits to family physicians (n = 56) by 1141 adults at one Northern California academic health center. MAIN OUTCOMES AND MEASURES We used 6 Consumer Assessment of Healthcare Providers and Systems Clinician and Group Adult Visit Survey items to measure patient satisfaction with the visit physician. Standardized items were averaged to form the satisfaction score (Cronbach α = 0.80), which was then percentile-transformed. Seven separate linear mixed-effects models examined the adjusted mean differences in patient satisfaction percentile associated with denial of each of the following requests (if present)-referral, pain medication, antibiotic, other new medication, laboratory test, radiology test, or other test-compared with fulfillment of the respective requests. The models adjusted for patient sociodemographics, weight, health status, personality, worry over health, prior visit with clinician, and the other 6 request categories and their dispositions. RESULTS The mean (SD) age of the 1141 patients was 45.6 (16.1) years, and 902 (68.4%) were female. Among 1319 visits, 897 (68.0%) included at least 1 request; 1441 (85.2%) were fulfilled. Requests by category were referral, 294 (21.1%); pain medication, 271 (20.5%); antibiotic, 107 (8.1%); other new medication, 271 (20.5%); laboratory test, 448 (34.0%); radiology test, 153 (11.6%); and other tests, 147 (11.1%). Compared with fulfillment of the respective request type, clinician denials of requests for referral, pain medication, other new medication, and laboratory test were associated with worse satisfaction (adjusted mean percentile differences, −19.75 [95% CI, −30.75 to −8.74], −10.72 [95% CI, −19.66 to −1.78], −20.36 [95% CI, −29.54 to −11.18], and −9.19 [95% CI, −17.50 to −0.87]), respectively. CONCLUSIONS AND RELEVANCE Clinician denial of some types of requests was associated with worse patient satisfaction with the clinician, but not for others, when compared with fulfillment of the requests. In an era of patient satisfaction-driven compensation, the findings suggest the need to train clinicians to deal effectively with requests, potentially enhancing patient and clinician experiences.

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Section: Discussionmentioning

confidence: 99%

Association of Clinician Denial of Patient Requests With Patient Satisfaction

et al. 2018

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“…These measures will backup physicians and allow them to provide better health care. Also, other techniques can help healthcare workers, for example watchful waiting [34]. A proper and trustful communication, between provider and patients have demonstrated in previous studies to improve outcomes and lowering the incidence of low value practice [25].…”

Section: Discussionmentioning

confidence: 99%

Low-value care practice in headache: a Spanish mixed methods research study

et al. 2020

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Background: Headache is one of the most prevalent diseases. The Global Burden of Disease Study ranks it as the seventh most common disease overall and the second largest neurological cause of disability in the world. The "Do Not Do" recommendations are a strategy for increasing the quality of care and reducing the cost of care for headache. This study aimed to identify specific low-value practices in headache care, determine their frequency, and estimate the cost overrun that they represent, in order to establish "Do not Do" recommendations specifically for headache by consensus and according to scientific evidence. Methods: This was a mixed methods research study that combined qualitative consensus-building techniques, involving a multidisciplinary panel of experts to define the "Do Not Do" recommendations in headache care, and a retrospective observational study with review of a randomized set of patient records from the past 6 months in four hospitals, to quantify the frequency of these "Do Not Do" practices. We calculated the sum of direct costs of medical consultations, medicines, and unnecessary diagnostic tests. Results: Seven "Do Not Do" recommendations were established for headache. In total, 3507 medical records were randomly reviewed. Low-value practices had a highly variable occurrence, depending on the hospital and type of headache. Overall, 34.1% of low-value practices were related to treatment, 21% were related to overuse of imaging in consultation, and 19% were related to emergency care. The estimated cost of low-value practices in the four hospitals was 203,520.47 euros per 1000 patients. Conclusions: This study identified low-value headache practices that need to be eradicated and provided data on their frequency and cost overruns.

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“…One such example was visits perceived as unnecessary that led to increasing other LVC because physicians responded to patients' inappropriate requests in order to feel that they had done something for the patients. Studies on unnecessary visits have mainly focused on emergency department visits of patients with non-acute problems (45,46). Reorganization with more available primary care does not seem to lessen the problem but could release a latent need for physician visits as health care becomes more available (39).…”

Section: Discussionmentioning

confidence: 99%

“…However, Zikmund-Fisher et al suggested that a bigger concern than the prevalence of patient requests is that the physicians perceive the requests as a barrier for reducing LVC (44). Tannenbaum and colleagues (45) found that patients who were informed about the risks with a LVC were less likely to demand a LVC and teaching physicians speci c communication strategies seems to be helpful in reducing the use of LVC (46).…”

Section: Discussionmentioning

confidence: 99%

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. 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.

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Watchful Waiting Strategy May Reduce Low-Value Diagnostic Testing

Cited by 15 publications

References 26 publications

Association of Clinician Denial of Patient Requests With Patient Satisfaction

Association of Clinician Denial of Patient Requests With Patient Satisfaction

Low-value care practice in headache: a Spanish mixed methods research study

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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