Tara F Bishop1, Meagan Cea2, Yesenia Miranda2, Robert Kim3, Meredith Lash-Dardia4, Jennifer I Lee5, Peter Steel6, Jordan Goldberg7, Elaine Mechanic7, Victoria Fener7, Linda M Gerber8. 1. Division of Health Economics and Policy, Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, United States; Division of General Internal Medicine, Department of Medicine, Weill Cornell Medical College, New York, NY, United States. Electronic address: tlfernan@med.cornell.edu. 2. Division of Health Economics and Policy, Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, United States. 3. Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York, NY, United States. 4. Division of Primary Care, Department of Medicine, Weill Cornell Medical College, New York, NY, United States. 5. Division of Hospital Medicine, Department of Medicine, Weill Cornell Medical College, New York, NY, United States. 6. Division of Emergency Medicine, Department of Medicine, Weill Cornell Medical College, New York, NY, United States. 7. stickK, LLC, New York, NY, United States. 8. Division of Biostatistics and Epidemiology, Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, United States.
Abstract
BACKGROUND: In 2012, the American Board of Internal Medicine (ABIM) Foundation launched a campaign called Choosing Wisely which was intended to start a national dialogue on services that are not medically necessary. More research is needed on the in-depth reasons why doctors overuse low-value services, their views on Choosing Wisely specifically, and ways to help them change their practice patterns. METHODS: We performed a qualitative study of focus groups with physicians to explore their views on the problem of overuse of low-value services, the reasons why they overuse, and ways that they think could be effective at curbing overuse. Participants were attendings in the fields of emergency medicine, internal medicine, hospital medicine, and cardiology. RESULTS: All physicians felt that overuse of low-value services was a significant problem. Physicians frequently cited that patient expectations drove the use of low-value services and lack of time was the most cited reason why behavior change was difficult. Facilitators that could promote behavior change included decision support through the electronic medical record, motivation to maintain their reputation among their colleagues, internal motivation to be a good doctor, objective data showing their rates of overuse, alignment of institutional goals, and forums to discuss evidence and new research. CONCLUSIONS AND IMPLICATIONS: In focus groups with physicians, we found that physicians perceived that overuse of low-value services was a problem. Participants cited many barriers to behavior change. Methods that help address patient expectations, physician time, and social norms may help physicians reduce their use of low-value services.
BACKGROUND: In 2012, the American Board of Internal Medicine (ABIM) Foundation launched a campaign called Choosing Wisely which was intended to start a national dialogue on services that are not medically necessary. More research is needed on the in-depth reasons why doctors overuse low-value services, their views on Choosing Wisely specifically, and ways to help them change their practice patterns. METHODS: We performed a qualitative study of focus groups with physicians to explore their views on the problem of overuse of low-value services, the reasons why they overuse, and ways that they think could be effective at curbing overuse. Participants were attendings in the fields of emergency medicine, internal medicine, hospital medicine, and cardiology. RESULTS: All physicians felt that overuse of low-value services was a significant problem. Physicians frequently cited that patient expectations drove the use of low-value services and lack of time was the most cited reason why behavior change was difficult. Facilitators that could promote behavior change included decision support through the electronic medical record, motivation to maintain their reputation among their colleagues, internal motivation to be a good doctor, objective data showing their rates of overuse, alignment of institutional goals, and forums to discuss evidence and new research. CONCLUSIONS AND IMPLICATIONS: In focus groups with physicians, we found that physicians perceived that overuse of low-value services was a problem. Participants cited many barriers to behavior change. Methods that help address patient expectations, physician time, and social norms may help physicians reduce their use of low-value services.
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