Kline Kristopher P, Shaw Leslee, Beyth Rebecca J, Plumb Jared, Nguyen Linda, Huo Tianyao, Winchester David E
Department of Medicine, College of Medicine, University of Florida, Gainesville, FL, USA.
Department of Medicine, Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA.
BMC Health Serv Res. 2017 Aug 11;17(1):553. doi: 10.1186/s12913-017-2510-y.
Despite efforts by professional societies to reduce low value care, many reports indicate that unnecessary tests, such as nuclear myocardial perfusion imaging (MPI), are commonly used in contemporary practice. The degree to which lack of awareness and professional liability concerns drive these behaviors warrants further study. We sought to investigate patient and provider perceptions about MPI in asymptomatic patients, the Choosing Wisely (CW) campaign, and professional liability concerns.
We administered an anonymous, paper-based survey with both discrete and open-response queries to subjects in multiple outpatient settings at our facilities. The survey was completed by 456 respondents including 342 patients and 114 physicians and advanced practice providers between May and August 2014. Our outcome was to compare patient and provider perceptions about MPI in asymptomatic patients and related factors.
Patients were more likely than providers to report that MPI was justified for asymptomatic patients (e.g. asymptomatic with family history of heart disease 75% versus 9.2%, p < 0.0001). In free responses to the question "What would be an inappropriate reason for MPI?" many responses echoed the goals of CW (for example, "If you don't have symptoms", "If the test is too risky", "For screening or in asymptomatic patients"). A minority of providers were aware of CW while even fewer patients were aware (37.2% versus 2.7%, p < 0.0001). Over one third of providers (38.9%) admitted to ordering MPI out of concern for professional liability including 48.3% of VA affiliated providers.
While some patients and providers are aware of the low value of MPI in patients without symptoms, others are enthusiastic to use it for a variety of scenarios. Concerns about professional liability likely contribute, even in the VA setting. Awareness of the Choosing Wisely campaign is low in both groups.
尽管专业协会努力减少低价值医疗服务，但许多报告表明，在当代医疗实践中，诸如核素心肌灌注显像（MPI）等不必要的检查仍普遍使用。缺乏认识和职业责任担忧在多大程度上导致了这些行为，值得进一步研究。我们试图调查患者和医疗服务提供者对无症状患者MPI检查、明智选择（CW）运动以及职业责任担忧的看法。
我们在本机构的多个门诊环境中，对受试者进行了一项包含离散型和开放式问题的匿名纸质调查。2014年5月至8月期间，共有456名受访者完成了该调查，其中包括342名患者以及114名医生和高级执业医疗人员。我们的研究结果是比较患者和医疗服务提供者对无症状患者MPI检查及相关因素的看法。
患者比医疗服务提供者更倾向于认为MPI检查对无症状患者是合理的（例如，有心脏病家族史的无症状患者，75%的患者认为合理，而医疗服务提供者中这一比例为9.2%，p<0.0001）。在对“MPI检查的不恰当理由是什么？”这一问题的开放式回答中，许多回答与明智选择运动的目标一致（例如，“如果你没有症状”、“如果检查风险太大”、“用于筛查或无症状患者”）。少数医疗服务提供者知晓明智选择运动，而知晓的患者更少（37.2%对2.7%，p<0.0001）。超过三分之一的医疗服务提供者（38.9%）承认因担心职业责任而开具MPI检查，其中包括48.3%隶属于退伍军人事务部（VA）的医疗服务提供者。
虽然一些患者和医疗服务提供者意识到MPI检查对无症状患者价值不大，但另一些人热衷于在各种情况下使用它。即使在退伍军人事务部环境中，对职业责任的担忧可能也起到了一定作用。两组对明智选择运动的知晓度都很低。
