Family Physicians' Knowledge of Commonly Overused Treatments and Tests

Maurer, Douglas; Stephens, Mark B.; Reamy, Brian V.; Crownover, Brian; Crawford, Paul; Chang, Tammy

doi:10.3122/jabfm.2014.05.140003

Cited by 10 publications

(3 citation statements)

References 15 publications

(8 reference statements)

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“…Fewer respondents demonstrated knowledge of sinusitis and electrocardiography use recommendations, with 66.5% and 61.4%, respectively, completing those cases correctly. 16 In our cohort, knowledge of guidelines was associated with greater cost-consciousness. It was not, however, associated with less use of lowvalue services.…”

Section: Maurer Et Almentioning

confidence: 63%

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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Section: Maurer Et Almentioning

confidence: 63%

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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“…39 The primary limitation to this study is the low response rate, particularly from prescribers, although our response rate was not dissimilar from other physician-based surveys. 15,18,40 It is possible that some respondents completed the survey more than once, since reminders were sent to the original study population. We were also unable to determine specific responses by facilities due to the anonymous design of the survey.…”

Section: Discussionmentioning

confidence: 99%

Antimicrobial Stewardship Knowledge, Attitudes, and Practices among Health Care Professionals at Small Community Hospitals

et al. 2016

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Background Very little is known about antimicrobial stewardship knowledge, attitudes, and practices (KAP) among health care practitioners in small, community hospitals (SCHs) compared to large community hospitals (LCHs). Objective To compare infectious diseases (ID) clinical resources and describe KAP pertaining to antimicrobial stewardship among prescribers, pharmacists, and administrators from a large hospital network including a comparison between SCHs and LCHs. Methods An anonymous 48-item antimicrobial stewardship KAP survey was administered to pharmacists, prescribers, and administrators at 15 SCH (<200 beds) and 5 LCHs (>200 beds) within an integrated health care network. Results In total, 588 (14%) completed the survey: 198 from SCHs and 390 from LCHs. Most respondents were familiar or very familiar with the term antimicrobial stewardship and felt that antimicrobial stewardship was necessary. Most pharmacists and prescribers agreed that antimicrobials were overused at their hospital. However, SCH pharmacists and prescribers were more likely to disagree that antibiotic resistance is a significant problem locally. Pharmacists saw restrictions as a reasonable method of controlling antibiotic use more than prescribers. SCH practitioners were less familiar with IDSA guidelines and less likely to rely on ID specialists to a greater extent than LCH practitioners. Most respondents strongly agreed they would like more antimicrobial education. Conclusion SCH and LCH pharmacists, prescribers, and administrators are aware of antimicrobial resistance and overuse and agree that antimicrobial stewardship programs are necessary. SCHs are less likely to contact ID for information. These results support the development of antimicrobial stewardship programs at SCHs, while recognizing the significant differences in availability and utilization of resources.

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“…M ost experts consider the current level of health care spending to be unsustainable and identify the overuse of unnecessary health services as a primary driver of the cost. [1][2][3][4][5] Medical practice variation is a terminology originated in the 1970s, 6 which has important implications for both health care and health policy. 7,8 Medical practice variation reflects practice differences among health care clinicians and includes overuse and underuse, both of which can have negative consequences for patients.…”

Section: Introductionmentioning

confidence: 99%

Medical Practice Variation Among Primary Care Physicians: 1 Decade, 14 Health Services, and 3,238,498 Patient-Years

et al. 2021

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PURPOSE Variation in medical practice is associated with poorer health outcomes, increased costs, disparities in care, and increased burden on the public health system. In the present study, we sought to describe and assess inter-and intra-primary care physician variation, adjusted for patient and clinic characteristics, over a decade of practice and across a broad range of health services. METHODSWe assessed practice patterns of 251 primary care physicians in southern Israel. For each of 14 health services (imaging tests, cardiac tests, laboratory tests, and specialist visits) we described interphysician and intraphysician variation, adjusted for patient case mix and clinic characteristics, using the coefficient of variation. The adjusted rates were assessed by generalized linear negativebinomial mixed models. RESULTSThe variation between physicians was on average 3-fold greater than the variation of individual physician practice over the years. Services with low utilization were associated with greater inter-and intraphysician variation: r s = (−0.58), P = .03 and r s = (−0.39), P = .17, respectively. In addition, physician utilization ranks averaged over all health services were consistent across the 14 health services (intraclass correlation coefficient, 0.94; 95% CI, 0.93-0.95).CONCLUSIONS Our results show greater variation in practice patterns between physicians than for individual physicians over the years. It appears that the variation remains high even after adjustment for patient and clinic characteristics and that the individual physician utilization patterns are stable across health services. We propose that personal behavioral characteristics of medical practitioners might explain this variation.

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Family Physicians' Knowledge of Commonly Overused Treatments and Tests

Cited by 10 publications

References 15 publications

Physician Cost Consciousness and Use of Low-Value Clinical Services

Physician Cost Consciousness and Use of Low-Value Clinical Services

Antimicrobial Stewardship Knowledge, Attitudes, and Practices among Health Care Professionals at Small Community Hospitals

Medical Practice Variation Among Primary Care Physicians: 1 Decade, 14 Health Services, and 3,238,498 Patient-Years

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