title: Primary Care Clinicians' Perspectives on Reducing Low-Value Care in an Integrated Delivery System.
abstract: BACKGROUND
  Perceptions about low-value care (eg, medical tests and procedures that may be unnecessary and/or harmful) among clinicians with capitated salaries are unknown.
  
  
  OBJECTIVE
  Explore clinicians' perceived use of and responsibility for reducing low-value care by focusing on barriers to use, awareness of the Choosing Wisely campaign, and response to reports of peer-comparison resource use and practice patterns.
  
  
  METHODS
  Electronic, cross-sectional survey, distributed in 2013, to 304 salaried primary care physicians and physician assistants at Group Health Cooperative.
  
  
  METHODS
  Attitudes, awareness, and barriers of low-value care strategies and initiatives.
  
  
  RESULTS
  A total of 189 clinicians responded (62% response rate). More than 90% believe cost is important to various stakeholders and believe it is fair to ask clinicians to be cost-conscious. Most found peer-comparison resource-use reports useful for understanding practice patterns and prompting peer discussions. Two-thirds of clinicians were aware of the Choosing Wisely campaign; among them, 97% considered it a legitimate information source. Although 88% reported being comfortable discussing low-value care with patients, 80% reported they would order tests or procedures when a patient insisted. As key barriers in reducing low-value care, clinicians identified time constraints (45%), overcoming patient preferences/values (44%), community standards (43%), fear of patients' dissatisfaction (41%), patients' knowledge about the harms of low-value care (38%), and availability of tools to support shared decision making (37%).
  
  
  CONCLUSIONS
  Salaried clinicians are aware of rising health care costs and want to be stewards of limited health care resources. Evidence-based initiatives such as the Choosing Wisely campaign may help motivate clinicians to be conscientious stewards of limited health care resources.
authors.affiliation: Scientific Investigator at the Group Health Research Institute in Seattle, WA. buist.d@ghc.org.
authors.forename: Diana S M
authors.initials: DS
authors.lastname: Buist
authors.affiliation: Research Public Health Analyst at RTI International in Waltham, MA. echang@rti.org.
authors.forename: Eva
authors.initials: E
authors.lastname: Chang
authors.affiliation: Medical Director of Quality at Group Health Physicians in Seattle, WA. handley.m@ghc.org.
authors.forename: Matt
authors.initials: M
authors.lastname: Handley
authors.affiliation: Programmer for the Group Health Research Institute in Seattle, WA. pardee.r@ghc.org.
authors.forename: Roy
authors.initials: R
authors.lastname: Pardee
authors.affiliation: Research Project Manager at the Group Health Research Institute in Seattle, WA. gundersen.g@ghc.org.
authors.forename: Gabrielle
authors.initials: G
authors.lastname: Gundersen
authors.affiliation: Director of the Center for Community Health and Evaluation for the Group Health Research Institute in Seattle, WA. cheadle.a@ghc.org.
authors.forename: Allen
authors.initials: A
authors.lastname: Cheadle
authors.affiliation: Chief Scientist at Trillium Health Partners Institute for Better Health in Mississauga, Ontario, Canada. robert.reid@trilliumhealthpartners.ca.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Reid
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003363:Cost Control; D003430:Cross-Sectional Studies; D019033:Delivery of Health Care, Integrated; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D010823:Physician Assistants / Q000523:psychology; D058007:Physicians, Primary Care / Q000523:psychology; D011787:Quality of Health Care / Q000592:standards*; D014481:United States; D062505:Value-Based Purchasing