Physician Characteristics Associated With Ordering 4 Low-Value Screening Tests in Primary Care

Area of Science:

• Health Services Research
• Primary Care Medicine
• Health Economics

Background:

• Reducing low-value tests and treatments in primary care is challenging, as broad interventions often fail.
• Most physicians order low-value care infrequently, making widespread interventions less effective.

Purpose of the Study:

• To identify primary care physicians who frequently order low-value screening tests.
• To characterize physicians with high rates of ordering low-value care.

Main Methods:

• Retrospective cohort study using administrative health care claims from Ontario, Canada (April 2012-March 2016).
• Measured physician-level ordering rates for four low-value screening tests: repeated dual-energy x-ray absorptiometry (DXA) scans, electrocardiograms (ECGs), Papanicolaou (Pap) tests, and chest radiographs (CXRs).
• Physicians were categorized based on their propensity to order low-value care across tests.

Main Results:

• The study included 2394 primary care physicians.
• A significant proportion of low-value tests (39.2%) were ordered by a small group of physicians (18.4%) identified as 'generalized frequent users'.
• Factors associated with frequent low-value test ordering included male sex, longer time since medical school graduation, and specific payment models.

Conclusions:

• A distinct group of primary care physicians were identified as frequent orderers of low-value screening tests.
• Targeted interventions focused on these 'generalized frequent users' may be a more effective strategy for reducing overall low-value care.