What interventions do general practitioners recommend avoiding? A nationwide survey from Switzerland
To address low-value interventions in healthcare, “Choosing Wisely” campaigns provide recommendations of interventions to avoid (RIAs). These are usually developed by expert panels rather than general practitioners (GPs). The aim of our study was to develop RIAs for ambulatory general medicine based on the suggestions of GPs, with their involvement from the very beginning.
This was a nationwide online Delphi survey among Swiss Society of General Internal Medicine members. In round one, each participant suggested two interventions perceived as particularly inappropriate. In round two, the 16 most frequent RIAs were rated by importance on a 0–100 scale and compared with “Choosing Wisely” lists. We calculated descriptive statistics for suggestions and importance ratings, and used regression models to search for associations with GP characteristics.
Response rates were 7.4% (538/7318) for round one and 18.2% (1357/7468) for round two. GPs provided 1074 suggestions. Out of the 16 most frequent RIAs, 13 corresponded to existing “Choosing Wisely” lists. The RIAs rated most important were: antibiotics in viral infections, unnecessarily duplicated tests and imaging in unspecific low back pain (means 88.5–91.7, standard deviations 18.6–19.9). None of the GPs’ characteristics were associated with any of the five highest rated RIAs except for working in a hospital setting.
Most RIA suggestions from GPs were concordant with previously published recommendations of interventions to avoid, independently of GPs knowledge of these and reflecting their high clinical relevance. In addition, our study revealed some more relevant topics and may help to develop future “Choosing Wisely” recommendations, with the final goal to reduce low-value care.
- Parchman ML, Henrikson NB, Blasi PR, Buist DS, Penfold R, Austin B, et al. Taking action on overuse: Creating the culture for change. Healthc (Amst). 2017;5(4):199–203. doi:.https://doi.org/10.1016/j.hjdsi.2016.10.005
- https://www.choosingwisely.org (accessed 2019 December 13)
- https://www.smartermedicine.ch (accessed 2019 December 13)
- Selby K, Gaspoz JM, Rodondi N, Neuner-Jehle S, Perrier A, Zeller A, et al. Creating a list of low-value health care activities in Swiss primary care. JAMA Intern Med. 2015;175(4):640–2. doi:.https://doi.org/10.1001/jamainternmed.2014.8111
- Santa JS. Communicating information about “what not to do” to consumers. BMC Med Inform Decis Mak. 2013;13(S3, Suppl 3):S2. doi:.https://doi.org/10.1186/1472-6947-13-S3-S2
- Rosenberg A, Agiro A, Gottlieb M, Barron J, Brady P, Liu Y, et al. Early trends among seven recommendations from the choosing wisely campaign. JAMA Intern Med. 2015;175(12):1913–20. doi:.https://doi.org/10.1001/jamainternmed.2015.5441
- Hasson H, Nilsen P, Augustsson H, Ingvarsson S, Korlén S, von Thiele Schwarz U. To do or not to do-balancing governance and professional autonomy to abandon low-value practices: a study protocol. Implement Sci. 2019;14(1):70. doi:.https://doi.org/10.1186/s13012-019-0919-x
- Robert G, Harlock J, Williams I. Disentangling rhetoric and reality: an international Delphi study of factors and processes that facilitate the successful implementation of decisions to decommission healthcare services. Implement Sci. 2014;9(1):123. doi:.https://doi.org/10.1186/s13012-014-0123-y
- Grady D, Redberg RF, Mallon WK. How should top-five lists be developed?: what is the next step? JAMA Intern Med. 2014;174(4):498–9. doi:.https://doi.org/10.1001/jamainternmed.2013.8272
- Schuur JD, Carney DP, Lyn ET, Raja AS, Michael JA, Ross NG, et al. A top-five list for emergency medicine: a pilot project to improve the value of emergency care. JAMA Intern Med. 2014;174(4):509–15. doi:.https://doi.org/10.1001/jamainternmed.2013.12688
- Atkinson P, Lang E, Mackenzie M, Hiranandani R, Lys R, Laupacis M, et al. CJEM Debate Series: #ChoosingWisely - The Choosing Wisely campaign will not impact physician behaviour and choices. CJEM. 2018;20(2):170–5. doi:.https://doi.org/10.1017/cem.2017.402
- Neuner-Jehle S, Senn O, Rosemann T. Neue „Choosing wisely“ Empfehlungen zu unangemessenen medizinischen Interventionen: Sicht von Schweizer Hausärzten [New “choosing wisely” recommendations of inappropriate interventions: The perspective of Swiss general practitioners]. Z Evid Fortbild Qual Gesundhwes. 2016;118-119:82–6. German. doi:.https://doi.org/10.1016/j.zefq.2016.09.001
- Turoff M, Hiltz S. Computer based Delphi processes. In: Adler M, Ziglio, E, editors. Gazing into the Oracle: The Delphi Method and its Application to Social Policy and Public Health. London: Jessica Kingsley Publishers; 1995. pp 56–88.
- SurveyMonkey Inc. San Mateo, California, USA, https://www.surveymonkey.com (accessed 2019 December 13)
- Swiss Medical Association (Foederatio Medicorum Helveticorum) Physicians’ Statistics. 2018, available from: https://www.fmh.ch (accessed 2019 December 13)
- Braun V, Clarke V. Thematic analysis. In: Cooper, editor. Handbook of research methods in psychology. Washington DC: APA books; 2012. pp 57–71.
- R Development Core Team. R: A language and environment for statistical computing. R Foundation for Statistical Computing V, Austria. 2008; ISBN 3-900051-07-0. https://www.R-project.org (accessed 2019 December 13)
- https://www.choosingwiselycanada.org (accessed 2019 December 13)
- https://www.choosingwisely.co.uk (accessed 2019 December 13)
- https://www.klug-entscheiden.com (accessed 2019 December 13)
- https://www.choosingwisely.org.au (accessed 2019 December 13)
- Selby K, Cornuz J, Cohidon C, Gaspoz JM, Senn N. How do Swiss general practitioners agree with and report adhering to a top-five list of unnecessary tests and treatments? Results of a cross-sectional survey. Eur J Gen Pract. 2018;24(1):32–8. doi:.https://doi.org/10.1080/13814788.2017.1395018
- Henderson JT, Weisman CS. Physician gender effects on preventive screening and counseling: an analysis of male and female patients’ health care experiences. Med Care. 2001;39(12):1281–92. doi:.https://doi.org/10.1097/00005650-200112000-00004
- Smith SM, Fahey T, Smucny J, Becker LA. Antibiotics for acute bronchitis. Cochrane Database Syst Rev. 2017;6(6):CD000245.
- Spinks A, Glasziou PP, Del Mar CB. Antibiotics for sore throat. Cochrane Database Syst Rev. 2013;(11):CD000023.
- https://www.star.admin.ch/star/en/home.html (accessed 2019 December 13)
- Osborn R, Squires D, Doty MM, Sarnak DO, Schneider EC. In new survey of eleven countries, US adults still struggle with access to and affordability of health care. Health Aff (Millwood). 2016;35(12):2327–36. doi:.https://doi.org/10.1377/hlthaff.2016.1088
- https://www.aafp.org/afp/recommendations/viewRecommendation.htm?recommendationId=281 (accessed 2020 April 29)
- https://www.choosingwisely.org/clinician-lists/american-association-blood-banks-serial-blood-counts-on-clinically-stable-patients (accessed 2020 April 29)
- https://www.choosingwisely.org/clinician-lists/critical-care-societies-collaborative-regular-diagnostic-tests (accessed 2020 April 29)
- Procop GW, Yerian LM, Wyllie R, Harrison AM, Kottke-Marchant K. Duplicate laboratory test reduction using a clinical decision support tool. Am J Clin Pathol. 2014;141(5):718–23. doi:.https://doi.org/10.1309/AJCPOWHOIZBZ3FRW
- Rao VM, Levin DC. The overuse of diagnostic imaging and the Choosing Wisely initiative. Ann Intern Med. 2012;157(8):574–6. doi:.https://doi.org/10.7326/0003-4819-157-8-201210160-00535
- Cholesterol Treatment Trialists’ Collaboration. Efficacy and safety of statin therapy in older people: a meta-analysis of individual participant data from 28 randomised controlled trials. Lancet. 2019;393(10170):407–15. doi:.https://doi.org/10.1016/S0140-6736(18)31942-1
- Price S, Spencer A, Medina-Lara A, Hamilton W. Availability and use of cancer decision-support tools: a cross-sectional survey of UK primary care. Br J Gen Pract. 2019;69(684):e437–43. doi:.https://doi.org/10.3399/bjgp19X703745
- Breedvelt JJF, Zamperoni V, Kessler D, Riper H, Kleiboer AM, Elliott I, et al. GPs’ attitudes towards digital technologies for depression: an online survey in primary care. Br J Gen Pract. 2019;69(680):e164–70. doi:.https://doi.org/10.3399/bjgp18X700721
- Hall LH, Johnson J, Watt I, O’Connor DB. Association of GP wellbeing and burnout with patient safety in UK primary care: a cross-sectional survey. Br J Gen Pract. 2019;69(684):e507–14. doi:.https://doi.org/10.3399/bjgp19X702713