Primary Care Provider Perspectives on Reducing Low-Value Care

Background/Aims: Constraining costs and enhancing value in health care delivery is a national priority. Understanding the clinician perspective is particularly important because health care professionals play key roles in choosing what health care services are used. This study explores clinicians’ perceived use of and professional responsibility for reducing low-value care, barriers to decreasing its use, and knowledge and perceived legitimacy of the Choosing Wisely campaign. Methods: We conducted an online survey of 304 primary care clinicians at Group Health in Fall 2013. The overall response rate was 62% (n=189). Results: Nearly all (93%) responded that the cost of care they personally deliver is important to different stakeholders and believe it is fair to ask providers to be cost-conscious. Over half (62%) said patients request unnecessary tests or procedures at least several times per week. The majority indicated they were somewhat or completely comfortable discussing low-value care with colleagues (70%) and patients (88%); conversations with patients were reported much more frequently than with providers (10% and 56% five or more discussions in the past 30 days, respectively). Providers indicated patients follow their advice the majority of the time about unnecessary tests or procedures when conversations happen. Notable perceived barriers to decreasing low-value care included: time (45%), community standards (43%), challenges overcoming patient preferences and values (43%), fear of patients’ dissatisfaction (40%), patients’ knowledge about harms of having low-value care (37%), availability of tools to support relevant shared decision-making (36%) and fear of litigation (31%). Almost two-thirds of providers were aware of the national Choosing Wisely campaign, nearly all of which considered it a legitimate source of information on unnecessary tests and procedures. Discussion: There were few differences in national physician surveys and our survey of integrated delivery system clinicians — patients listen to their providers and the majority of providers report talking with patients about reasons to avoid unnecessary tests. Awareness and perceived legitimacy of the Choosing Wisely campaign suggests the campaign and others like it may be used to activate providers to be conscientious stewards of limited health care resources. Additional focus on training providers to have discussions with colleagues about low-value care could be beneficial