Physician-suggested strategies for deimplementing low-value care in Swedish primary care: a qualitative analysis...

Low-value care (LVC) remains a persistent problem in primary healthcare. While various implementation strategies have been proposed and tested for deimplementation, there is limited knowledge about whether there are strategies uniquely suited to deimplementation. Furthermore, there is limited knowledge about system-level responsibilities for deimplementation. Given that implementation strategies are recommended to be tailored to the specific contextual factors surrounding LVC practices, involving primary care physicians in identifying contextually appropriate strategies holds promise. This study aimed to explore the strategies that primary care physicians suggest could facilitate the deimplementation of LVC and map them to the system levels responsible for initiating and deploying these strategies.

This qualitative study was based on responses to an open-ended survey question asking physicians to suggest strategies that could facilitate the deimplementation of LVC practices within primary healthcare in Sweden. A national sample of 441 primary care physicians responded. Responses were analyzed via deductive content analysis categorized by the Expert Recommendations for Implementing Change (ERIC) compilation. Responses that could not be categorized via ERIC were analyzed inductively. The identified strategies were then mapped to the system levels (individual, group, leader, organization and overarching system) responsible for deploying these strategies.

Strategies were identified across all nine original ERIC domains, representing 39 (53%) of the original ERIC strategies, and later additions for deimplementation. Additionally, a set of strategies categorized under a new domain, develop better evidence, was identified. Most strategies were suitable for deployment at the organizational (31 strategies) and overarching (31 strategies) levels. Sixteen strategies were best suited for the group level, thirteen for the leadership level, and two for the individual level.

Primary care physicians proposed strategies across all nine ERIC domains, with additional strategies beyond those previously described, including develop better evidence. From the physicians' perspective, deimplementation cannot rely solely on individuals but requires coordinated action across the organizational and system levels. Broader structural, policy, and cultural changes would support physicians and ensure that responsibility for deimplementation is shared across the healthcare system.