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'Choosing Wisely' culture among Brazilian cardiologists
Luis C L Correia1,2, Guilherme B Barcellos3, Vitor Calixto2
1Hospital São Rafael, Av. São Rafael, 2152 - São Marcos, Salvador - BA, Brazil.
Insights
Brazilian cardiologists show modest support for the 'Choosing Wisely' initiative, with older physicians and interventionists less likely to avoid wasteful care. This suggests potential cultural barriers to adopting evidence-based practices.
Area of Science:
- Cardiology
- Health Services Research
- Medical Ethics
Background:
- The 'Choosing Wisely' campaign promotes reducing unnecessary medical tests and procedures.
- Understanding physician alignment with 'Choosing Wisely' is crucial for healthcare efficiency.
- Wasteful care in cardiology contributes to increased healthcare costs and potential patient harm.
Purpose of the Study:
- To assess the alignment of the 'Choosing Wisely' concept with Brazilian cardiologists' medical culture.
- To identify predictors influencing cardiologists' preferences for avoiding wasteful medical care.
Main Methods:
- A cross-sectional study involving cardiologists affiliated with the Brazilian Society of Cardiology.
- A web questionnaire was used to collect data from 621 cardiologists.
- Participants rated 13 'do not do' recommendations on a scale of 1 to 10.
Main Results:
- Support for 'Choosing Wisely' recommendations ranged from modest to moderate, with no recommendation receiving strong support (mean score >9).
- The highest-rated recommendation was against routine percutaneous coronary intervention in asymptomatic individuals (mean score = 8.0 ± 2.9).
- Being an interventionist and longer time since graduation were negatively associated with supporting 'Choosing Wisely' recommendations.
Conclusions:
- Brazilian cardiologists exhibit modest to moderate support for the 'Choosing Wisely' initiative.
- Factors such as physician age and specialization (interventionists) may hinder the adoption of practices aimed at reducing wasteful care.
Objective:
(i) To describe how aligned the 'Choosing Wisely' concept is with the medical culture among Brazilian cardiologists and (ii) to identify predictors for physicians' preference for avoiding wasteful care.
Design:
Cross-sectional study.
Setting:
Brazilian Society of Cardiology.
Participants:
Cardiologists who agree to fill a web questionary.
Intervention:
A task force of 12 Brazilian cardiologists prepared a list of 13 'do not do' recommendations, which were made available on the Brazilian Society of Cardiology website for affiliates to assign a supported score of 1 to 10 to each recommendation.
Main Outcome Measurement:
Score average for supporting recommendations.
Results:
Of 14 579 Brazilian cardiologists, 621 (4.3%) answered the questionnaire. The top recommendation was 'do not perform routine percutaneous coronary intervention in asymptomatic individuals' (mean score = 8.0 ± 2.9) while the one with the lowest support was 'do not use an intra-aortic balloon pump in infarction with cardiogenic shock' (5.8 ± 3.2). None of the 13 recommendations presented a mean grade >9 (strong support); 7 recommendations averaged 7-8 (moderate support) followed by 6 recommendations with an average of 5-7 (modest support). Multivariate analysis independently identified predictors of the score attributed to the top recommendation; being an interventionist and time since graduation were both negatively associated with support.
Conclusions:
(i) The support of Brazilian cardiologists for the 'Choosing Wisely' concept is modest to moderate, and (ii) older generations and enthusiasm towards the procedure one performs may be factors against the 'Choosing Wisely' philosophy.