To protect themselves from the potential harms of low value care, patients must take an active role in clinical decision making
Low value care is care that is ineffective, harmful or confers marginal benefit at disproportionately high cost.1 Professionally‐led campaigns such as Choosing Wisely Australia and the Royal Australasian College of Physicians’ EVOLVE program aim to reduce the prevalence of such care. However, similar overseas campaigns have been marred by selective focus on infrequent, low impact, or less financially lucrative practices;2 uncertainty about the most effective de‐adoption strategies;3 and limited success to date in reducing overuse.4 While clinician‐targeted education programs, audit and feedback, and decision support feature prominently, evidence appears stronger and impact seems greater for strategies directed to, or mediated by, patients.5
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- 1. Scott IA, Duckett S. In search of professional consensus around defining and reducing low value care. Med J Aust 2015; 203: 179–181. https://www.mja.com.au/journal/2015/203/4/search-professional-consensus-defining-and-reducing-low-value-care
- 2. Zadro JR, Farey J, Harris IA, Maher CG. Do Choosing Wisely recommendations about low‐value care target income generating treatments provided by members? A content analysis of 1293 recommendations. BMC Health Serv Res 2019; 19: 707.
- 3. Colla CH, Mainor AJ, Hargreaves C, et al. Interventions aimed at reducing use of low‐value health services: a systematic review. Med Care Res Rev 2017; 74: 507–550.
- 4. Henderson J, Bouck Z, Holleman R, et al. Comparison of payment changes and Choosing Wisely recommendations for use of low‐value laboratory tests in the United States and Canada. JAMA Intern Med 2020; 180: 524–531.
- 5. Morgan DJ, Leppin AL, Smith CD, Korenstein D. A practical framework for understanding and reducing medical overuse: Conceptualizing overuse through the patient‐clinician interaction. J Hosp Med 2017; 12: 346–351.
- 6. Tilburt JC, Wynia MK, Sheeler RD, et al. Views of US physicians about controlling health care costs. JAMA 2013; 310: 380–388.
- 7. Schleifer D, Rothman DJ. “The ultimate decision is yours”: exploring patients’ attitudes about the overuse of medical interventions. PLoS One 2012; 7: e52552.
- 8. Liao JM, Schapira MS, Navathe AS, et al. The effect of emphasizing patient, societal, and institutional harms of inappropriate antibiotic prescribing on physician support of financial penalties: a randomized trial. Ann Intern Med 2017; 167: 215–216.
- 9. Korenstein D, Chimonas S, Barrow B, et al. Development of a conceptual map of negative consequences for patients of overuse of medical tests and treatments. JAMA Intern Med 2018; 178: 1401–1407.
- 10. Ganguli I, Simpkin A, Lupo C, et al. Cascades of care after incidental findings in a US national survey of physicians. JAMA Netw Open 2019; 2: e1913325.
- 11. Badgery‐Parker T, Pearson SA, Dunn S, Elshaug AG. Measuring hospital‐acquired complications associated with low‐value care. JAMA Intern Med 2019; 179: 499–505.
- 12. Canzoniero JV, Afshar E, Hedian H, et al. Unnecessary hospitalisation and related harm for patients with low risk syncope. JAMA Intern Med 2015; 175: 1065–1067.
- 13. Jacobs JC, Jarvik JG, Chou R, et al. Observational study of the downstream consequences of inappropriate MRI of the lumbar spine. J Gen Intern Med 2020; 35: 3605–3612.
- 14. Farjah F, Monsell SE, Gould MK, et al. Association of the intensity of diagnostic evaluation with outcomes in incidentally detected lung nodules. JAMA Intern Med 2021; 181: 480–489.
- 15. Tamma PD, Avdic E, Li DX, et al. Association of adverse events with antibiotic use in hospitalized patients. JAMA Intern Med 2017; 177: 1308–1315.
- 16. Schaefer JK, Errickson J, Li Y, et al. Adverse events associated with the addition of aspirin to direct oral anticoagulant therapy without a clear indication. JAMA Intern Med 2021; 181: 817–824.
- 17. Green AR, Tung M, Segal JB. Older adults’ perceptions of the causes and consequences of healthcare overuse: a qualitative study. J Gen Intern Med 2018; 33: 892–897.
- 18. Sypes EE, de Grood C, Whalen‐Browne L, et al. Engaging patients in de‐implementation interventions to reduce low‐value clinical care: a systematic review and meta‐analysis. BMC Med 2020; 18: 116.
- 19. Couet N, Desroches S, Robitaille H, et al. Assessments of the extent to which health‐care providers involve patients in decision making: a systematic review of studies using the OPTION instrument. Health Expect 2015; 18: 542–561.
- 20. Fønhus MS, Dalsbø TK, Johansen M, et al. Patient‐mediated interventions to improve professional practice. Cochrane Database Syst Rev 2018; (9): CD012472.
- 21. Hoffmann TC, Légaré F, Simmons MB, et al. Shared decision making: what do clinicians need to know and why should they bother? Med J Aust 2014; 201: 35–39. https://www.mja.com.au/journal/2014/201/1/shared-decision-making-what-do-clinicians-need-know-and-why-should-they-bother
- 22. Légaré F, Adekpedjou R, Stacey D, et al. Interventions for increasing the use of shared decision making by healthcare professionals. Cochrane Database Syst Rev 2018; (7): CD006732.
- 23. Hughes TM, Merath K, Chen O, et al. Association of shared decision‐making on patient‐reported health outcomes and healthcare utilization. Am J Surg 2018; 216: 7–12.
- 24. Joseph‐Williams N, Elwyn G, Edwards A. Knowledge is not power for patients: a systematic review and thematic synthesis of patient‐reported barriers and facilitators to shared decision making. Patient Educ Couns 2014; 94: 291–309.
- 25. Romano MJ, Segal JB, Pollack CE. The association between continuity of care and the overuse of medical procedures. JAMA Intern Med 2015; 175: 1148–1154.
- 26. Santa JS. Communicating information about “what not to do” to consumers. BMC Med Inform Decis Mak 2013; 13 (Suppl): S2.
- 27. Shepherd HL, Barratt A, Jones A, et al. Can consumers learn to ask three questions to improve shared decision making? A feasibility study of the ASK (AskShareKnow) patient–clinician communication model intervention in a primary health‐care setting. Health Expect 2016; 19: 1160–1168.
- 28. Health Education England. Person‐centred approaches: empowering people in their lives and communities to enable an upgrade in prevention, wellbeing, health, care and support. Health Education England, Skills for Health, Skills for Care; 2017. https://skillsforhealth.org.uk/wp-content/uploads/2021/01/Person-Centred-Approaches-Framework.pdf (viewed June 2021).
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Adam Elshaug reports personal fees from the Australian Department of Health, the NSW Bureau of Health Information, Cancer Australia, Queensland Health, Victoria Department of Health and Human Services, SA Health, and Private Healthcare Australia; grants from HCF Research Foundation, the National Health and Medical Research Council, the Medical Research Future Fund, the Laura and John Arnold Foundation, and the Australian Department of Veterans Affairs, outside the submitted work. Melissa Fox reports grants and personal fees from Queensland Health, and personal fees from the Australian Commission on Safety and Quality in Health Care, outside the submitted work.