US internists' awareness and use of overtreatment guidelines: a national survey

To assess physician views and perceived adoption of overtreatment guidelines and measure whether adoption of these guidelines influenced the recommendation of a targeted service.

A cross-sectional survey mailed from July 2014 to January 2015 to 902 internists who completed residency between 2003 and 2013, randomly selected from the American Medical Association Masterfile.

Poisson regression was used to model the rate of recommending a targeted service included in the guidelines, based on the level of guideline adoption.

A total of 456 physicians responded (51% response rate). Most expressed familiarity with overtreatment guidelines (88.5%), a comfort level with discussing these guidelines with patients (79.9%), and described overtreatment guidelines as a useful tool in their practice (81.6%). Physicians in the highest tertile of guideline adoption reported double-digit rates of recommending antibiotics for sinusitis (29.7%), mammogram at end of life (16.5%), and electrocardiogram testing for asymptomatic patients (11.0%). Physicians in the bottom tertile of guideline adoption reported lower rates of recommending x rays (-12.0%; 95% confidence interval [CI], -19.4% to -4.5%; P = .002), magnetic resonance imaging for lower back pain (-4.8%; 95% CI, -8.1% to -1.5%; P = .004), and cardiac testing for asymptomatic patients (-10.2%; 95% CI, -18.9% to -1.5%; P = .02).

US internal medicine physicians who completed residency between 2003 and 2013 reported high levels of adoption of overtreatment guidelines. Physicians who reported the highest levels of guideline adoption reported recommending services targeted by these guidelines in their practice.