title: A conceptual framework for understanding and reducing overuse by primary care providers.
abstract: Primary care providers frequently recommend, administer, or prescribe health care services that are unlikely to benefit their patients. Yet little is known about how to reduce provider overuse behavior. In the absence of a theoretically grounded causal framework, it is difficult to predict the contexts under which different types of interventions to reduce provider overuse will succeed and under which they will fail. In this article, we present a framework based on the theory of planned behavior that is designed to guide overuse research and intervention development. We describe categories of primary care provider beliefs that lead to the formation of intentions to assess the appropriateness of services, and propose factors that may affect whether the presence of assessment intentions results in an appropriate recommendation. Interventions that have been commonly used to address provider overuse behavior are reviewed within the context of the framework.
authors.affiliation: 1Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN, USA.
authors.forename: Adam A
authors.initials: AA
authors.lastname: Powell
authors.forename: Hanna E
authors.initials: HE
authors.lastname: Bloomfield
authors.forename: Diana J
authors.initials: DJ
authors.lastname: Burgess
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Wilt
authors.forename: Melissa R
authors.initials: MR
authors.lastname: Partin
mesh_terms: D003657:Decision Making; D006300:Health Services Misuse / Q000517:prevention & control*; D006801:Humans; D058007:Physicians, Primary Care; D012017:Referral and Consultation
keywords: inappropriate care; overuse; physician decision making; theory of planned behavior; theory of reasoned action