Article Figures & Data
Tables
- Table 1.
Potential Barriers to Clinical Guideline Adherence within in Each of 3 Domains, as Collected by the Questionnaire
Sequence of Behavior Change Barrier to Guideline Adherence Questionnaire Item Knowledge Lack of awareness 2 Knowledge questions for each clinical service Lack of familiarity I am very familiar with the clinical guidelines about this service. Attitudes Applicability to patient Guidelines about this service rarely apply to the patients I see. Not cost-beneficial There is strong evidence about the limited benefits of providing this service. Lack of self-efficacy I am confident in my ability to discuss the utility of this clinical service with patients. Lack of motivation/inertia I find it hard to break old habits and decrease use of this clinical service for patients. Practices Reconciling patient preferences Patient preferences strongly influence my decision making about providing this service. Lack of time I have adequate time in most clinical encounters to address the appropriateness of providing this clinical service to my patients. Lack of resources I don't have adequate resources in my practice to help me address this issue. Characteristic Result Participants Who Responded (n) Age (years), mean (SD) 51.3 (11.3) 135 Sex 136 Male 74 (54.4) Female 62 (45.6) Specialty 135 Family Medicine 96 (71.1) Internal Medicine 39 (28.8) Patients seen/half day (n), mean (SD) 10.0 (3.1) 133 Does your practice participate in any “value-based” insurance contracts? 132 Yes 59 (44.7) No 42 (31.8) Not sure 31 (23.5) Is your practice incorporated into an ACO? 132 Yes 53 (40.2) No 47 (35.6) Not sure 32 (24.2) NCQA certified patient-centered medical home? 132 Yes 46 (34.8) No 66 (50.0) Not sure 20 (15.2) Familiar with the Choosing WiselyTM campaign? 136 Very familiar 22 (16.2) Somewhat familiar 35 (25.7) Unfamiliar 79 (58.1) Data are n (%) unless otherwise indicated.
ACO, accountable care organization; NCQA, National Committee for Quality Assurance; SD, standard deviation.
- Table 3.
Participant-Reported Use of, Knowledge about, and Perceived Barriers to 5 Choosing WiselyTM Low-Value Services
Choosing WiselyTM Service Self-Reported Use Knowledge Score Perceived Attitudinal Barriers Perceived Practice Barriers Imaging for back pain No. of participants who responded 143 143 143 143 Mean (SD) 1.7 (2.0) 5.4 (1.7) 8.3 (2.1) 7.5 (2.0) Sinusitis treatment No. of participants who responded 138 143 143 143 Mean (SD) 3.9 (2.7) 6.0 (1.6) 9.0 (2.2) 7.8 (2.1) Osteoporosis screening No. of participants who responded 137 143 143 143 Mean (SD) 2.3 (2.8) 5.4 (1.7) 9.9 (2.3) 7.7 (2.0) ECG screening No. of participants who responded 137 143 143 143 Mean (SD) 0.9 (2.0) 4.1 (1.5) 9.2 (2.3) 7.3 (2.0) Pap test No. of participants who responded 140 143 143 143 Mean (SD) 0.2 (0.8) 5.3 (1.6) 8.2 (2.8) 6.9 (2.0) Composite score No. of participants who responded 143 143 143 143 Mean (SD) 8.7 (6.4) 26.2 (4.8) 44.6 (8.2) 37.2 (7.3) Green shading highlights better performance/limited barriers. Red shading highlights lowest performance/most barriers.
ECG, electrocardiography; SD, standard deviation
- Table 4.
Associations between Degree of Familiarity with the Choosing WiselyTM Campaign and Cost Conscious Score and Low-Value Service Use Score
How Familiar are You with the Choosing Wisely Campaign? P Value* Very Familiar (n = 22) Somewhat Familiar (n = 35) Unfamiliar (n = 79) Cost conscious score 31.82 33.00 30.33 Mean 2.92 3.86 3.85 Standard deviation (30.52–33.11) (31.67–34.33) (29.47–31.19) 95% Confidence interval .002 Low-value service use score 6.64 7.00 9.89 Mean 5.29 5.13 6.69 Standard deviation (4.29–8.98) (5.24–8.76) (8.39–11.38) 95% Confidence interval .02 ↵* For cost conscious score, only one pairwise comparison was significant: physicians who were somewhat familiar had significantly higher score compared to those unfamiliar with the Choosing Wisely campaign (P = .002).
For low-value service use score, even though the overall test was significant (P = .02), none of the pairwise comparison was significant.
