In the JournalsPerspective

Choosing Wisely helpful, but many physicians unaware of the campaign

While awareness of the Choosing Wisely campaign was low among physicians, a majority of those who knew of the campaign reported that it was helpful and valuable, according to data published in Health Affairs.

“Low-value care ... is widespread in the United States,” Carrie H. Colla, PhD, and Alexander J. Mainor, JD, MPH, both from the Dartmouth Institute for Health Policy and Clinical Practice, wrote. “It is commonly estimated that up to 30% of care is waste, which contributes substantially to costs.”

The ABIM Foundation’s Choosing Wisely campaign was created in 2012 to address low-value care and promote awareness about avoiding unnecessary tests, treatments and procedures, but it has not made a significant difference on physician or patient behavior, according to Colla and Mainor.

The researchers evaluated physicians’ views on and awareness of the use of low-value care by evaluating and comparing the results of two telephone surveys. The surveys were administered by the ABIM in 2014 (n = 600) and 2017 (n = 601) and asked practicing physicians (PCPs and specialists) about contributors to low-value care and their exposure to the Choosing Wisely campaign.

Results showed that awareness of the Choosing Wisely campaign only increased modestly from 21% in 2014 to 25% in 2017. Most respondents reported being “very comfortable” with discussing why a patient should avoid a low-value test or procedure; however, the proportion dropped significantly between 2014 and 2017 from 82% to 74%. In 2014, 42% of participants reported that these discussions had gotten more difficult, which increased slightly to 46% in 2017.

Most respondents who knew of Choosing Wisely reported that the campaign was helpful (81% in 2014 and 86% in 2017) and valuable (91% in 2014 and 93% in 2017) for physicians. The 2017 survey indicated that physicians most commonly reported malpractice concerns (87%), desire for more information to lessen uncertainty (84%) and “just to be safe” (78%) as justifications for low-value care.

“Future steps to increase the take-up of Choosing Wisely recommendations could include increasing the involvement of patients, making a greater effort to promote shared decision-making as part of a multifaceted strategy, encouraging the explicit consideration of existing biases, and increasing systematic efforts to test interventions for value before they are introduced into clinical practice,” Colla and Mainor concluded.

“Multifaceted interventions that reinforce the Choosing Wisely guidelines through personalized education, continued follow-up and tailored feedback will be necessary to overcome the substantial perceived and real barriers to reducing the use of low-value care,” they added. – by Alaina Tedesco

Disclosure: Colla and Mainor report receiving support from ABIM and AHRQ.

While awareness of the Choosing Wisely campaign was low among physicians, a majority of those who knew of the campaign reported that it was helpful and valuable, according to data published in Health Affairs.

“Low-value care ... is widespread in the United States,” Carrie H. Colla, PhD, and Alexander J. Mainor, JD, MPH, both from the Dartmouth Institute for Health Policy and Clinical Practice, wrote. “It is commonly estimated that up to 30% of care is waste, which contributes substantially to costs.”

The ABIM Foundation’s Choosing Wisely campaign was created in 2012 to address low-value care and promote awareness about avoiding unnecessary tests, treatments and procedures, but it has not made a significant difference on physician or patient behavior, according to Colla and Mainor.

The researchers evaluated physicians’ views on and awareness of the use of low-value care by evaluating and comparing the results of two telephone surveys. The surveys were administered by the ABIM in 2014 (n = 600) and 2017 (n = 601) and asked practicing physicians (PCPs and specialists) about contributors to low-value care and their exposure to the Choosing Wisely campaign.

Results showed that awareness of the Choosing Wisely campaign only increased modestly from 21% in 2014 to 25% in 2017. Most respondents reported being “very comfortable” with discussing why a patient should avoid a low-value test or procedure; however, the proportion dropped significantly between 2014 and 2017 from 82% to 74%. In 2014, 42% of participants reported that these discussions had gotten more difficult, which increased slightly to 46% in 2017.

Most respondents who knew of Choosing Wisely reported that the campaign was helpful (81% in 2014 and 86% in 2017) and valuable (91% in 2014 and 93% in 2017) for physicians. The 2017 survey indicated that physicians most commonly reported malpractice concerns (87%), desire for more information to lessen uncertainty (84%) and “just to be safe” (78%) as justifications for low-value care.

“Future steps to increase the take-up of Choosing Wisely recommendations could include increasing the involvement of patients, making a greater effort to promote shared decision-making as part of a multifaceted strategy, encouraging the explicit consideration of existing biases, and increasing systematic efforts to test interventions for value before they are introduced into clinical practice,” Colla and Mainor concluded.

“Multifaceted interventions that reinforce the Choosing Wisely guidelines through personalized education, continued follow-up and tailored feedback will be necessary to overcome the substantial perceived and real barriers to reducing the use of low-value care,” they added. – by Alaina Tedesco

Disclosure: Colla and Mainor report receiving support from ABIM and AHRQ.

    Perspective
    Daniel Wolfson

    Daniel Wolfson

    ABIM Foundation values the recent research from Health Affairs about the Choosing Wisely campaign. Feedback from practicing physicians is instructive because it illuminates challenges and opportunities that the campaign can explore as we continue to advance conversations about what care is appropriate. We appreciate the guidance the authors offered at the conclusion of their article about ways to increase implementation of Choosing Wisely recommendations and reduce barriers to decreasing low-value care.

    In the first five years, Choosing Wisely has shifted from solely raising awareness about low-value care to also encouraging reductions of low-value care in practice. In the next five years, the campaign hopes to create more partnerships that expand its reach and to collect more data on the reductions in low-value care we are already beginning to see.

    • Daniel Wolfson, MHSA
    • Executive VP and COO of ABIM Foundation

    Disclosures: Wolfson reports no relevant financial disclosures.