Choosing Wisely, an ABIM Foundation campaign that started in 2012 to improve clinical conversations with patients about avoiding low-value care, has not made changes in physician or patient behaviors concerning low-value care.
The report published in Health Affairs found that barriers to physicians adopting Choosing Wisely recommendations included concerns about malpractice, patient demand and satisfaction and doctors’ need for more information to “reduce uncertainty.”
The report suggested possible ways to reduce low-value services include “multifaceted interventions that reinforce guidelines through personalized education, follow-up and feedback, as well as aligned financial incentives.”
The ABIM Foundation is made up of national medical specialty societies and works with Consumer Reports on the project to “help providers, patients and other healthcare stakeholders think and talk about overuse of healthcare resources in the United States.” The foundation creates Choosing Wisely lists that provide evidence-based recommendations for clinicians and patients. The lists include information as to when tests and procedures may be appropriate.
Low-value care remains a concern in healthcare despite efforts like Choosing Wisely. Up to 30% of care is considered wasteful, which inflates healthcare costs. Choosing Wisely seeks to reduce those low-value services by educating doctors, who, in turn, educate patients.
The ABIM Foundation administered surveys in 2014 and 2017 to gauge physicians’ knowledge of Choosing Wisely, if they are following the campaign’s recommendations about preventing low-value care discussions and whether they’re talking to patients about the topic.
The surveys found that only one-quarter of physicians knew of the program in 2017, which was only four percentage points better than three years earlier. This result was despite publicity and physician outreach efforts. Primary care physicians were more apt to know about the program than specialists. The report found that physicians familiar with Choosing Wisely think the campaign is worthwhile, but it still hasn’t had much of an effect on physician or patient behavior.
The percentage of physicians reporting that talking to patients about avoiding low-value service “had gotten harder” increased from 42% to 46% in that period.
Low health literacy is an issue for patients. A recently UnitedHealth Group survey found that most Americans struggle with both health literacy and understanding basic health insurance terms, such as premiums and deductibles.