ArticleBMJ open2018
Drivers and strategies for avoiding overuse. A cross-sectional study to explore the experience of Spanish primary care providers handling uncertainty and patients' requests.
Article in BMJ open, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 21 papers, 1 of them a synthesis that pooled it.
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Who cites it
21 citing papers in PubMed, 1 synthesis or guideline pooled it.
- How defensive medicine is defined in European medical literature: a systematic review.BMJ open · 2022Pooled it
- Physicians' Attitudes Toward Unnecessary Medical Services: Ethical and Systemic Challenges in Fourth Level Prevention - Tehran 2024.Medical journal of the Islamic Republic of Iran · 2026Article
- 'Harm? I don't think so!': medical overuse from the perspective of allied health professionals in Germany - a qualitative study.BMJ open · 2025Article
- Descriptive study of claims in primary care during the year 2022 in a health area of Spain.Clinics (Sao Paulo, Brazil) · 2025Article
- Factors associated with patients' demand for low-value care: a scoping review.BMC health services research · 2024Article
- Low-value practices in primary care: a cross-sectional study comparing data between males and females in Spain.BMJ open · 2024Observational
- 'The health care system is more like a business'-medical overuse from the patients' perspective in Germany: a qualitative study.BMJ open · 2024Article
- The influence of fears of perceived legal consequences on general practitioners' practice in relation to defensive medicine - a cross-sectional survey in Germany.BMC primary care · 2024Article
- Gender Disparities in Adverse Events Resulting From Low-Value Practices in Family Practice in Spain: A Retrospective Cohort Study.International journal of public health · 2024Article
- What do people know and think about medical overuse? an online questionnaire study in Germany.PloS one · 2024Article
- Understanding Healthcare Personnel's Perceptions About Reducing Low-Value Care: A Scoping Review.Risk management and healthcare policy · 2024Article
- The Assessment of the Rationale for Urgent Head CT-Comparative Analysis of Referrals and Results of Examinations without and with Contrast Enhancement.Medicina (Kaunas, Lithuania) · 2022Article
- Catalan experience of deadoption of low-value practices in primary care.BMJ open quality · 2022Article
- A Choosing Wisely top-5 list to support general practitioners in Austria.Wiener medizinische Wochenschrift (1946) · 2021Article
- How artificial intelligence can help us 'Choose Wisely'.Bioelectronic medicine · 2021Article
- Overuse and underuse of cardiovascular diagnostic and therapeutic procedures for community-dwelling adults: a protocol for a systematic review.HRB open research · 2021Article
- Estimation of the Overuse of Preoperative Chest X-rays According to "Choosing Wisely", "No Hacer", and "Essencial" Initiatives: Are They Equally Applicable and Comparable?International journal of environmental research and public health · 2020Observational
- Low-value care practice in headache: a Spanish mixed methods research study.The journal of headache and pain · 2020Article
- Identifying and de-implementing low-value care in primary care: the GP's perspective-a cross-sectional survey.BMJ open · 2020Article
- Why Not? Persuading Clinicians to Reduce Overuse.Mayo Clinic proceedings. Innovations, quality & outcomes · 2020Article
Corrections and comments
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Authors and funding
8 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesIdentify the sources of overuse from the point of view of the Spanish primary care professionals, and analyse the frequency of overuse due to pressure from patients in addition to the responses when professionals face these demands.
designA cross-sectional study.
settingPrimary care in Spain.
participantsA non-randomised sample of 2201 providers (general practitioners, paediatricians and nurses) was recruited during the survey. PRIMARY AND SECONDARY OUTCOME MEASURES: The frequency, causes and responsibility for overuse, the frequency that patients demand unnecessary tests or procedures, the profile of the most demanding patients, and arguments for dissuading the patient.
resultsIn all, 936 general practitioners, 682 paediatricians and 286 nurses replied (response rate 18.6%). Patient requests (67%) and defensive medicine (40%) were the most cited causes of overuse. Five hundred and twenty-two (27%) received requests from their patients almost every day for unnecessary tests or procedures, and 132 (7%) recognised granting the requests. The lack of time in consultation, and information about new medical advances and treatments that patients could find on printed and digital media, contributed to the professional's inability to adequately counter this pressure by patients. Clinical safety (49.9%) and evidence (39.4%) were the arguments that dissuaded patients from their requests the most. Cost savings was not a convincing argument (6.8%), above all for paediatricians (4.3%). General practitioners resisted more pressure from their patients (x
conclusionSatisfying the patient and patient uncertainty about what should be done and defensive medicine practices explains some of the frequent causes of overuse. Safety arguments are useful to dissuade patients from their requests.
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