Academic physicians' views on low-value services and the choosing wisely campaign: A qualitative study

Area of Science:

• Health Services Research
• Medical Practice Management
• Physician Behavior

Background:

• The Choosing Wisely campaign, initiated in 2012 by the American Board of Internal Medicine (ABIM) Foundation, aims to reduce medically unnecessary services.
• Further investigation is required into physician motivations for overusing low-value services and their perspectives on practice pattern modification.

Purpose of the Study:

• To explore physicians' perceptions of low-value service overuse.
• To identify reasons behind the overuse of low-value services.
• To determine effective strategies for curbing overuse.

Main Methods:

• A qualitative study employing focus groups was conducted with physicians.
• Participants included attendings from emergency medicine, internal medicine, hospital medicine, and cardiology.

Main Results:

• Physicians universally identified the overuse of low-value services as a significant issue.
• Key drivers for overuse include patient expectations and time limitations, hindering behavior change.
• Effective facilitators for change encompass electronic medical record decision support, professional reputation, intrinsic motivation, objective performance data, institutional alignment, and evidence-based discussion forums.

Conclusions:

• Physicians perceive the overuse of low-value services as a substantial problem with numerous barriers to behavior change.
• Interventions targeting patient expectations, physician time constraints, and social norms are crucial for reducing low-value care.