Additional interventions are needed for Choosing Wisely recommendations to be used more widely in general practice, according to an article published online in JAMA Internal Medicine. Researchers analyzed seven clinical services and found significant declines for only two of them.
The researchers evaluated the frequency and trends after the launch of the earliest Choosing Wisely recommendations in 2012. They used medical and pharmacy claims from Anthem-affiliated Blue Cross and Blue Shield health care plans for about 25 million members.
Most notably, the use of imaging for headaches went down from 14.9 to 13.4 percent and cardiac imaging for members who don’t have a history of cardiac conditions declined from 10.8 to 9.7 percent. Antibiotic use for sinusitis decreased moderately from 84.5 to 83.7 and use of pre-operative chest X-rays and imaging for low back pain stayed high.
The researchers also found that there were increases in a couple of the services. The use of nonsteroidal anti-inflammatory drugs for patients with hypertension, heart failure or chronic kidney disease increased from 14.4 to 16.2 percent and human papilloma virus testing for women under 30 years old went up from 4.8 to 6 percent, despite recommendations.
The Choosing Wisely campaign’s goal is to get physicians, patients and other health care stakeholders to think about and discuss the overuse of health care resources in the U.S. Over 70 lists of about 400 recommendations of frequently used medical procedures have been compiled.
According to the researchers, the small changes in utilization mean that more interventions are going to be required for broader implementation of the recommendations. In addition, more interventions are needed. These could range from data feedback, physician communication training, systems interventions, clinician scorecards, patient-focused strategies and financial incentives.
In a related commentary, Dr. Ralph Gonzales and Dr. Adithya Cattamanchi of the University of California, San Francisco wrote that delivery systems and clinician groups should develop and test strategies that aim to reduce the use of low-value treatments and diagnostics.
“Further efforts to compel delivery systems to commit to Choosing Wisely are needed to leverage the grassroots/front line cultural shifts that the campaign has stimulated before the impact wanes,” they wrote.
In another commentary, David H. Howard of Emory University and Dr. Cary P. Gross of Yale University of Medicine wrote that an initiative to fund trials that compared established medical treatments with less expensive alternatives should be used to supplement continuing efforts to cut low-value care.
“There is a need for evidence that will guide decisions about clinical care. Instead of asking, 'Does evidence affect practice?' we ought to be asking, 'How can we produce more of it?,'" they wrote.
