What interventions do general practitioners recommend avoiding? A nationwide survey from Switzerland

Area of Science:

• Healthcare research
• General internal medicine
• Health services research

Background:

• "Choosing Wisely" campaigns aim to reduce low-value healthcare interventions.
• Recommendations for interventions to avoid (RIAs) are typically expert-driven.
• General practitioners' (GPs) perspectives are underrepresented in RIA development.

Purpose of the Study:

• To develop RIAs for ambulatory general medicine.
• To incorporate GPs' suggestions from the outset.
• To identify high-priority interventions for avoidance.

Main Methods:

• Nationwide online Delphi survey of Swiss Society of General Internal Medicine members.
• Round one: GPs suggested inappropriate interventions.
• Round two: Top 16 RIAs rated for importance and compared to existing lists.

Main Results:

• 1074 GP suggestions received; 13 of 16 frequent RIAs matched existing lists.
• Top-rated RIAs: antibiotics for viral infections, duplicated tests for low back pain.
• GP characteristics, except hospital setting, did not correlate with top RIA ratings.

Conclusions:

• GP-identified RIAs largely align with existing recommendations, confirming clinical relevance.
• Study highlights additional relevant topics for future "Choosing Wisely" initiatives.
• GP involvement enhances the development of effective strategies to reduce low-value care.