A survey of emergency medicine residents’ perspectives of the choosing wisely campaign

Greene, Stuart E.; Massone, Richard

doi:10.1016/j.ajem.2015.03.067

Cited by 8 publications

(9 citation statements)

References 1 publication

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Patient determinants typically acted as barriers to deimplementation. The most reported patient determinant was expectations from patients, which was as a barrier to de-implementation in five studies [84][85][86][87][88]. This included patients' opposition to de-implementation [84], patients' request for tests and treatments [85,86] and challenges overcoming patients' preferences and values and community standards of care [88].…”

Section: Patient Determinantsmentioning

confidence: 99%

“…All studies described barriers to de-implementation. The most common subcategory was professionals' expectations, attitudes and behaviour which consisted of clinicians resistance to change [84], fear of malpractice due to a "malpractice system" [85], lack of interest in saving money [90] and fear of litigation [87,88]. Professionals' knowledge included one study that described a gap in professionals knowledge about their actual use of the LVC practice which meant that they overestimated to what extent they had reduced their use [86].…”

Section: Professional Determinantsmentioning

confidence: 99%

See 1 more Smart Citation

Determinants for the use and de-implementation of low-value care in health care: a scoping review

Augustsson

Ingvarsson

Nilsén

et al. 2021

Implement Sci Commun

118

View full text Add to dashboard Cite

Background A considerable proportion of interventions provided to patients lack evidence of their effectiveness. This implies that patients may receive ineffective, unnecessary or even harmful care. However, despite some empirical studies in the field, there has been no synthesis of determinants impacting the use of low-value care (LVC) and the process of de-implementing LVC. Aim The aim was to identify determinants influencing the use of LVC, as well as determinants for de-implementation of LVC practices in health care. Methods A scoping review was performed based on the framework by Arksey and O’Malley. We searched four scientific databases, conducted snowball searches of relevant articles and hand searched the journal Implementation Science for peer-reviewed journal articles in English. Articles were included if they were empirical studies reporting on determinants for the use of LVC or de-implementation of LVC. The abstract review and the full-text review were conducted in duplicate and conflicting decisions were discussed until consensus was reached. Data were charted using a piloted data charting form and the determinants were inductively coded and categorised in an iterative process conducted by the project group. Results In total, 101 citations were included in the review. Of these, 92 reported on determinants for the use of LVC and nine on determinants for de-implementation. The studies were conducted in a range of health care settings and investigated a variety of LVC practices with LVC medication prescriptions, imaging and screening procedures being the most common. The identified determinants for the use of LVC as well as for de-implementation of LVC practices broadly concerned: patients, professionals, outer context, inner context, process and evidence and LVC practice. The results were discussed in relation to the Consolidated Framework for Implementation Research. Conclusion The identified determinants largely overlap with existing implementation frameworks, although patient expectations and professionals’ fear of malpractice appear to be more prominent determinants for the use and de-implementation of LVC. Thus, existing implementation determinant frameworks may require adaptation to be transferable to de-implementation. Strategies to reduce the use of LVC should specifically consider determinants for the use and de-implementation of LVC. Registration The review has not been registered.

show abstract

Section: Patient Determinantsmentioning

confidence: 99%

Section: Professional Determinantsmentioning

confidence: 99%

Determinants for the use and de-implementation of low-value care in health care: a scoping review

Augustsson

Ingvarsson

Nilsén

et al. 2021

Implement Sci Commun

118

View full text Add to dashboard Cite

show abstract

“…Two main principles underpin Choosing Wisely: (1) the responsible stewardship of healthcare resources and (2) the inclusion of patients in healthcare decisions 1. Numerous studies have been conducted to assess the implementation of Choosing Wisely in relation to responsible stewardship 2–5. There is mixed research in relation to shared decision-making.…”

Section: Introductionmentioning

confidence: 99%

Semistructured interviews regarding patients’ perceptions of Choosing Wisely and shared decision-making: an Australian study

et al. 2019

View full text Add to dashboard Cite

ObjectivesThis study aimed to examine how patients perceive shared decision-making regarding CT scan referral and use of the five Choosing Wisely questions with their general practitioner (GP).DesignThis is a qualitative exploratory study using semistructured interviews.SettingThis study was conducted in a large metropolitan public healthcare organisation in urban Australia.ParticipantsFollowing purposive sampling, 20 patients and 2 carers participated. Patient participants aged 18 years or older were eligible if they were attending the healthcare organisation for a CT scan and referred by their GP. Carers/family were eligible to participate when they were in the role of an unpaid carer and were aged 18 years or older. Participants were required to speak English sufficiently to provide informed consent. Participants with cognitive impairment were excluded.FindingsEighteen interviews were conducted with the patient only. Two interviews were conducted with the patient and the patient’s carer. Fourteen participants were female. Five themes resulted from the thematic analysis: (1) needing to know, (2) questioning doctors is not necessary, (3) discussing scans is not required, (4) uncertainty about questioning and (5) valuing the Choosing Wisely questions. Participants reported that they presented to their GP with a health problem that they needed to understand and address. Participants accepted their GPs decision to prescribe a CT scan to identify the nature of their problem. They reported ambivalence about engaging in shared decision-making with their doctor, although many participants reported valuing the Choosing Wisely questions.ConclusionsShared decision-making is an important principle underpinning Choosing Wisely. Practice implementation requires understanding patients’ motivations to engage in shared decision-making with a focus on attitudes, beliefs, knowledge and emotions. Systems-level support and education for healthcare practitioners in effective communication is important. However, this needs to emphasise communication with patients who have varying degrees of motivation to engage in shared decision-making and Choosing Wisely.

show abstract

“…Cost-effective, high-quality care is a component of the Accreditation Council for Graduate Medical Education (ACGME) Clinical Learning Environment Review (CLER) “pathways to excellence” and while relatively few internal medicine programs have a formal curriculum in cost-conscious care, almost 50% reported that they are working to create such programs. [ 11 – 12 ] A survey of emergency medicine residents found that almost all supported the Choosing Wisely campaign, though many barriers to implementation of the recommendations were cited[ 13 ]…”

Section: Discussionmentioning

confidence: 99%

Internal medicine trainees' knowledge and confidence in using the American Society of Hematology Choosing Wisely guidelines in hemostasis, thrombosis, and non-malignant hematology

et al. 2018

View full text Add to dashboard Cite

BackgroundSeveral specialty societies participate in the Choosing Wisely (CW) campaign in an attempt to reduce waste in health care spending. We surveyed internal medicine (IM) residents with an objective of classifying knowledge of and confidence in using the American Society of Hematology (ASH) CW principles in hemostasis, thrombosis, and non-malignant hematology.MethodsMulti-institutional study of IM residents at 5 academic training programs in the United States. A 10-question, case-based multiple choice test, with each question accompanied by a 5-point Likert-scale confidence assessment, was distributed electronically. Responses were summarized with frequencies and percentages or medians and ranges, as appropriate. Two sample t-tests or Wilcoxon rank-sum tests were used to compare confidence and knowledge scores.ResultsOf 892 IM residents, 174 (19.5%) responded to all questions. Overall, residents answered a median of 7 of 10 questions correctly (range 2–10) and median resident confidence in their responses was 3.1 (on a 5-point scale). Correct responses were significantly associated with higher confidence for all but one question. Having a hematology rotation experience was significantly associated with more correct responses and with higher confidence (p = 0.001 and p<0.001, respectively).ConclusionsIM residents at several academic hospitals have variable knowledge of ASH-CW guidelines in thrombosis and hemostasis/non-malignant hematology. Residents who have done hematology rotations, particularly a hematology consult rotation, were more likely to answer questions correctly and to be more confident that their answers were correct. Adequate clinical exposure and training in cost-effective care is essential to train clinicians who are cost-conscious in any specialty.

show abstract

A survey of emergency medicine residents’ perspectives of the choosing wisely campaign

Cited by 8 publications

References 1 publication

Determinants for the use and de-implementation of low-value care in health care: a scoping review

Determinants for the use and de-implementation of low-value care in health care: a scoping review

Semistructured interviews regarding patients’ perceptions of Choosing Wisely and shared decision-making: an Australian study

Internal medicine trainees' knowledge and confidence in using the American Society of Hematology Choosing Wisely guidelines in hemostasis, thrombosis, and non-malignant hematology

Contact Info

Product

Resources

About