Kevin R Riggs1, Peter A Ubel2,3,4,5, Brendan Saloner6,7. 1. Division of Preventive Medicine, University of Alabama at Birmingham, 1720 2nd Avenue South, MT 610, Birmingham, AL, 35294-4410, USA. kriggs@uab.edu. 2. Department of Medicine, Duke University School of Medicine, Durham, NC, USA. 3. Fuqua School of Business, Duke University, Durham, NC, USA. 4. Sanford School of Public Policy, Duke University, Durham, NC, USA. 5. Margolis Center for Health Policy, Duke University, Durham, NC, USA. 6. Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. 7. Johns Hopkins Berman Institute of Bioethics, Baltimore, MD, USA.
Abstract
BACKGROUND: A challenge to reducing overuse of health services is communicating recommendations against unnecessary health services to patients. The predominant approach has been to highlight the limited benefit and potential harm of such services for that patient, but the prudent use of health resources can also benefit others. Whether appealing to patient altruism can reduce overuse is unknown. OBJECTIVE: To determine whether altruistic appeals reduce hypothetical requests for overused services and affect physician ratings. DESIGN: Experimental survey using hypothetical vignettes describing three overused health services (antibiotics for acute sinusitis, imaging for acute low back pain, and annual exams for healthy adults). PARTICIPANTS: U.S. adults recruited from Research Now, an online panel of individuals compensated for performing academic and marketing research surveys. INTERVENTIONS: In the control version of the vignettes, the physician's rationale for recommending against the service was the minimal benefit and potential for harm. In the altruism version, the rationale additionally included potential benefit to others by forgoing that service. MAIN MEASURES: Differences in requests for overused services and physician ratings between participants randomized to the control and altruism versions of the vignettes. KEY RESULTS:A total of 1001 participants were included in the final analyses. There were no significant differences in requests for overused services for any of the clinical scenarios (P values ranged from 0.183 to 0.547). Physician ratings were lower in the altruism version for the acute sinusitis (6.68 vs. 7.03, P = 0.012) and back pain scenarios (6.14 vs. 6.83, P < 0.001), and marginally lower for the healthy adult scenario (5.27 vs. 5.57, P = 0.084). CONCLUSIONS: In this experimental survey, altruistic appeals delivered by physicians did not reduce requests for overused services, and resulted in more negative physician ratings. Further studies are warranted to determine whether alternative methods of appealing to patient altruism can reduce overuse.
RCT Entities:
BACKGROUND: A challenge to reducing overuse of health services is communicating recommendations against unnecessary health services to patients. The predominant approach has been to highlight the limited benefit and potential harm of such services for that patient, but the prudent use of health resources can also benefit others. Whether appealing to patient altruism can reduce overuse is unknown. OBJECTIVE: To determine whether altruistic appeals reduce hypothetical requests for overused services and affect physician ratings. DESIGN: Experimental survey using hypothetical vignettes describing three overused health services (antibiotics for acute sinusitis, imaging for acute low back pain, and annual exams for healthy adults). PARTICIPANTS: U.S. adults recruited from Research Now, an online panel of individuals compensated for performing academic and marketing research surveys. INTERVENTIONS: In the control version of the vignettes, the physician's rationale for recommending against the service was the minimal benefit and potential for harm. In the altruism version, the rationale additionally included potential benefit to others by forgoing that service. MAIN MEASURES: Differences in requests for overused services and physician ratings between participants randomized to the control and altruism versions of the vignettes. KEY RESULTS: A total of 1001 participants were included in the final analyses. There were no significant differences in requests for overused services for any of the clinical scenarios (P values ranged from 0.183 to 0.547). Physician ratings were lower in the altruism version for the acute sinusitis (6.68 vs. 7.03, P = 0.012) and back pain scenarios (6.14 vs. 6.83, P < 0.001), and marginally lower for the healthy adult scenario (5.27 vs. 5.57, P = 0.084). CONCLUSIONS: In this experimental survey, altruistic appeals delivered by physicians did not reduce requests for overused services, and resulted in more negative physician ratings. Further studies are warranted to determine whether alternative methods of appealing to patient altruism can reduce overuse.
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