title: Physician Cost Consciousness and Use of Low-Value Clinical Services.
abstract: Choosing WiselyTMengaged medical specialties, creating "top 5 lists" of low-value services. We describe primary care physicians' (PCPs') self-reported use of these services and perceived barriers to guideline adherence. We quantify physician cost consciousness and determine associations with use.
  
  
  
  PCP attendees of a continuing medical education conference completed a survey. For each Family Medicine Choosing Wisely behavior, participants reported clinical adherence. Likert scale items assessed perceived barriers. Low-value service frequency was the dependent variable. A validated Cost Consciousness Scale created the predictor variable. We hypothesized that participants with greater cost consciousness would report less frequent use of low-value services.
  
  
  
  Of 199 PCP attendees, 143 (72%) participated. Papanicolaou test after hysterectomy was performed least (0.2 mean services performed/10 patients). Provider knowledge of sinusitis treatment guidelines was greatest but provided most frequently (3.9 mean services performed/10 patients). Practice related barriers were perceived most frequently for adhering to sinusitis treatment guidelines. Attitudinal barriers were greatest for avoiding osteoporosis screening in low risk patients. Greater cost consciousness was associated with less use of low-value services (P = .03), greater knowledge of guidelines (P = .001), and fewer perceived attitudinal and practice behavior-related barriers (P < .001 for each). Greater knowledge of guidelines was not associated with less use of low-value services (P = .58). Familiarity with Choosing Wisely was associated with both greater cost consciousness (P = .004) and less use of low-value services (P = .03).
  
  
  
  Greater PCP cost consciousness was associated with less use of low-value services. Interventions to decrease perceived barriers and increase cost consciousness, perhaps by increasing awareness of Choosing Wisely, may translate into improved performance.
authors.affiliation: From the Department of Family Medicine, Mayo Clinic, Scottsdale, AZ (MG); the Division of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale (NA); the Division of Biostatistics, Mayo Clinic, Scottsdale (Y-HC); and Division of General Internal Medicine, Mayo Clinic, Rochester, MN (JT). grover.michael@mayo.edu.
authors.forename: Michael
authors.initials: M
authors.lastname: Grover
authors.affiliation: From the Department of Family Medicine, Mayo Clinic, Scottsdale, AZ (MG); the Division of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale (NA); the Division of Biostatistics, Mayo Clinic, Scottsdale (Y-HC); and Division of General Internal Medicine, Mayo Clinic, Rochester, MN (JT).
authors.forename: Neena
authors.initials: N
authors.lastname: Abraham
authors.affiliation: From the Department of Family Medicine, Mayo Clinic, Scottsdale, AZ (MG); the Division of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale (NA); the Division of Biostatistics, Mayo Clinic, Scottsdale (Y-HC); and Division of General Internal Medicine, Mayo Clinic, Rochester, MN (JT).
authors.forename: Yu-Hui
authors.initials: YH
authors.lastname: Chang
authors.affiliation: From the Department of Family Medicine, Mayo Clinic, Scottsdale, AZ (MG); the Division of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale (NA); the Division of Biostatistics, Mayo Clinic, Scottsdale (Y-HC); and Division of General Internal Medicine, Mayo Clinic, Rochester, MN (JT).
authors.forename: Jon
authors.initials: J
authors.lastname: Tilburt
mesh_terms: D001291:Attitude of Health Personnel; D005194:Family Practice / Q000191:economics* / Q000592:standards / Q000706:statistics & numerical data; D019983:Guideline Adherence; D017048:Health Care Costs; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008403:Mass Screening / Q000191:economics; D058007:Physicians, Primary Care; D010818:Practice Patterns, Physicians' / Q000191:economics* / Q000592:standards / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000191:economics* / Q000592:standards / Q000706:statistics & numerical data; D058996:Quality Improvement; D057566:Self Report; D014481:United States
keywords: Choice Behavior; Family Practice; Guideline Adherence; Hysterectomy; Osteoporosis; Papanicolaou Test; Physicians; Primary Care; Self Report; Sinusitis; Surveys and Questionnaires