ArticleBMC primary care2024
Perspectives on low-value care and barriers to de-implementation among primary care physicians: a multinational survey.
Article in BMC primary care, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers.
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Who cites it
13 citing papers in PubMed.
- Drivers and potential mitigation solutions for low-value medical imaging in Iran: a qualitative study.BMJ open · 2026Article
- Physician-suggested strategies for deimplementing low-value care in Swedish primary care: a qualitative analysis across system levels.Implementation science communications · 2026Article
- The role of electronic health records systems in de-implementing low-value care in primary care: a scoping review.Implementation science communications · 2025Review
- Low-Cost, High-Volume Health Services Contribute the Most to Unnecessary Health Spending due to Low-Value Care in Japan.medRxiv : the preprint server for health sciences · 2025Article
- Relative importance and interactions of factors influencing low-value care provision: a factorial survey experiment among Swedish primary care physicians.BMJ quality & safety · 2025Article
- Perceptions of the usefulness of Choosing Wisely among general practitioners in Norway: a nationwide survey.BMC primary care · 2025Article
- Primary Care Physician Characteristics and Low-Value Care Provision in Japan.JAMA health forum · 2025Article
- The Gatekeeper's Dilemma: Unpacking the Complexity of Low-Value Care in General Practice.Sociology of health & illness · 2025Article
- Factors associated with patients' demand for low-value care: a scoping review.BMC health services research · 2024Article
- Evaluation of the German living guideline "Protection against the Overuse and Underuse of Health Care" - an online survey among German GPs.BMC primary care · 2024Article
- 'The health care system is more like a business'-medical overuse from the patients' perspective in Germany: a qualitative study.BMJ open · 2024Article
- Reclaiming time in family medicine: Unnecessary clinical tasks as a hidden driver of workload burden.Canadian family physician Medecin de famille canadienArticle
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Authors and funding
16 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundHealthcare costs are rising worldwide. At the same time, a considerable proportion of care does not benefit or may even be harmful to patients. We aimed to explore attitudes towards low-value care and identify the most important barriers to the de-implementation of low-value care use in primary care in high-income countries.
methodsBetween May and June 2022, we email surveyed primary care physicians in six high-income countries (Austria, Finland, Greece, Italy, Japan, and Sweden). Physician respondents were eligible if they had worked in primary care during the previous 24 months. The survey included four sections with categorized questions on (1) background information, (2) familiarity with Choosing Wisely recommendations, (3) attitudes towards overdiagnosis and overtreatment, and (4) barriers to de-implementation, as well as a section with open-ended questions on interventions and possible facilitators for de-implementation. We used descriptive statistics to present the results.
resultsOf the 16,935 primary care physicians, 1,731 answered (response rate 10.2%), 1,505 had worked in primary care practice in the last 24 months and were included in the analysis. Of the respondents, 53% had read Choosing Wisely recommendations. Of the respondents, 52% perceived overdiagnosis and 50% overtreatment as at least a problem to some extent in their own practice. Corresponding figures were 85% and 81% when they were asked regarding their country's healthcare. Respondents considered patient expectations (85% answered either moderate or major importance), patient's requests for treatments and tests (83%), fear of medical error (81%), workload/lack of time (81%), and fear of underdiagnosis or undertreatment (79%) as the most important barriers for de-implementation. Attitudes and perceptions of barriers differed significantly between countries.
conclusionsMore than 80% of primary care physicians consider overtreatment and overdiagnosis as a problem in their country's healthcare but fewer (around 50%) in their own practice. Lack of time, fear of error, and patient pressures are common barriers to de-implementation in high-income countries and should be acknowledged when planning future healthcare. Due to the wide variety of barriers to de-implementation and differences in their importance in different contexts, understanding local barriers is crucial when planning de-implementation strategies.
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