Unwise Medical Choices Stubbornly Defy Eradication
Studies suggest both physicians and patients are reluctant to give up low-value healthcare services that waste money and can do more harm than good.
Turns out, it's not so easy to make wise choices about healthcare. Several new studies find that, even with urging, doctors and patients are having a hard time passing on low-value services, including many identified in the Choosing Wisely campaign.
Not that it should be a surprise. You don't need an MD to know that change is difficult.
The specialty societies of the Choosing Wisely campaign have offered up a menu of low-value services they suggest patients can live (well) without. The trick is to convince providers and patients to abandon superfluous old-reliables and "might-as-well" tests. They waste money and can do more harm than good.
Somehow, the message isn't getting through.
Stacey L. Sheridan, MD
A study out of University of California-Davis found that doctors who were coached on how to avoid low-value care were just as likely to order the tests as uncoached doctors. In a January Mayo Clinic study, nearly half of the doctors surveyed at Choosing Wisely CME sessions said they get daily requests for low-value services. They reported that a shrinking percentage of patients "always or almost always" followed their advice to skip the tests.
What About Decision Aids?
Researchers at the University of North Carolina, Chapel Hill set out to compare the efficacy of four different "evidence-based decision supports sheets" for prostate cancer screening in men 50 to 69 years old, osteoporosis screening in low-risk women ages 50 to 64 years old, and colorectal cancer screening in men and women between the ages 76 and 85 years. None of the support sheets had any impact.
Stacey L. Sheridan, MD, is a researcher at UNC's Sheps Center for Health Services Research and lead author of the study. Changing what patients and providers know about low-value services may not be enough to result in change the use those services.
Much more is required, she told me. "What the larger literature suggests is that it takes widespread change in culture and change in organizational structure and leadership to support… deimplementing low-value services," she says.
In the age of more-is-less in healthcare, we now need to deimplement, roll back, and undo. When a service is underused or not used, it is changed through implementation. When something is over-used, it needs to be deimplimented.