Identifying and de-implementing low-value care in primary care: the GP’s perspective—a cross-sectional survey

Abstract

ObjectiveGeneral practitioners have an important role in reducing low-value care as gatekeepers of the health system. The aim of this study was to assess the experiences of Dutch general practitioners regarding low-value care and to identify their needs to decrease low-value primary care.DesignWe performed a cross-sectional study.ParticipantsWe sent a survey to 500 general practitioners.SettingPrimary care in the Netherlands.Primary and secondary outcomesThe survey contained questions about the provision of low-value care and on clinical cases about lumbosacral spine X-rays in patients with low back pain and vitamin B12 laboratory tests without an evidence-based indication. We also asked general practitioners what they needed to reduce low-value care.ResultsA total of 182 general practitioners (37%) responded. 67% indicated that low-value care practices are regularly provided in general practice. 57% of the general practitioners have seen negative consequences of low-value care, in particular side effects of medication. The most provided low-value care practices are medication prescriptions such as antibiotics and laboratory tests such as vitamin B12 tests. The most reported drivers are patient-related. General practitioners want to maintain a good relationship with their patients by offering their patients an intervention instead of watchful waiting. Lack of time also plays a major role. In order to reduce low-value care, general practitioners suggested that educating patients on the value of tests and treatments might help. Supporting general practitioners and other healthcare professionals with clear guidelines as well as having more time for consultation were also mentioned by general practitioners.ConclusionGeneral practitioners are aware of providing unnecessary care despite their role as gatekeepers and have reasons for this. They need support in order to change their practice. This support might consist of better education of healthcare professionals and providing more time for consultation. Local and national media, such as websites and television, could be used to educate patients while guidelines could support professionals in reducing low-value care.

A review and perspective on the assessment, management and prevention of fragility fractures in patients with osteoporosis and chronic kidney disease

“…A further study in dialysis patients, the Dialysis Outcomes and Practice Patterns Study (DOPPS), showed an increase in fractures, including hip fractures, ranging from 1.5-fold to 8-fold that of the general population across all countries [ 18 ]. Just as in the general population, vertebral fractures are under-reported in CKD and dialysis cohorts, because vertebral imaging is performed relatively infrequently, and even actively discouraged in family medicine [ 19 ]. Hence, vertebral fractures may not be recognised as fracture events in CKD and dialysis patients, despite being associated with poorer clinical outcomes.…”

Prevalence of Low-Value Care and Its Associations with Patient-Centered Outcomes in Dementia

“…Reducing LvC could simultaneously lead to greater efficiency in the healthcare system and higher value for patient-centered outcomes [28]. However, a recent survey with general practitioners (GPs) revealed that LvC is highly present in routine care [29]. The increasing number of PwD and the associated increasing socioeconomic burden of disease lead to a need to identify and replace LvC within routine care efficiently.…”

Does De-Implementation of Low Value Care Impact the Patient-Clinician Relationship? A Mixed Methods Study

“…Additionally, multiple participants suggested LVC de-implementation as a potential enhancer of trust in their clinician, which con icts with commonly reported clinician concerns. 19,23,25 Investigations to explore the framing of LVC de-implementation as a means of enhancing trust are needed.…”

“…[19][20][21][22][23][24][25][26] Clinicians' prioritization of maintaining good relationships with patients is a speci c driver of low-value care. 19,20,27 However, investigations to explore the impact of low-value care de-implementation on the patient-clinician relationship are limited.…”

“…1,15,18 Although many factors contribute to the provision of LVC, one commonly cited barrier to deimplementation is clinicians' concern about negatively impacting patients' healthcare experience. [19][20][21][22][23][24][25][26] Clinicians' prioritization of maintaining good relationships with patients is a speci c driver of low-value care. 19,20,27 However, investigations to explore the impact of low-value care de-implementation on the patient-clinician relationship are limited.…”