Carrie H. Colla is an associate professor at the Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, in Lebanon, New Hampshire.
Alexander J. Mainor (
Health Aff (Millwood). 2017 Nov;36(11):2005-2011. doi: 10.1377/hlthaff.2017.0945. Epub 2017 Oct 24.
Together with physician specialty societies, the Choosing Wisely® campaign has codified recommendations of which health care services' use should be questioned and discussed with patients. The ABIM Foundation administered surveys in 2014 and 2017 to examine physicians' attitudes toward and awareness of the use of low-value care. The surveys included questions on the factors driving that use, physicians' comfort in having conversations with patients about that use, and physicians' exposure to the Choosing Wisely campaign. Despite continued publicity and physician outreach efforts, there were no significant changes between 2014 and 2017 in awareness of the campaign among physicians (awareness increased from 21 percent to 25 percent) or physician-reported difficulty in talking to patients about avoiding a low-value service (42 percent reported that such conversations had gotten harder in 2014, and 46 percent did so in 2017). Barriers to the adoption of recommendations included malpractice concerns, patient demand and satisfaction, and physicians' desire for more information to reduce uncertainty. Multifaceted interventions that reinforce guidelines through personalized education, follow-up, and feedback, as well as aligned financial incentives, should be pursued to reduce the use of low-value services.
与医师专业学会一起，“明智选择”运动将医疗服务使用的建议规范化，这些建议应与患者进行质疑和讨论。ABIM 基金会在 2014 年和 2017 年进行了调查，以研究医师对低价值医疗的使用的态度和认识。调查包括有关驱动因素、医师与患者就该使用进行对话的舒适度以及医师对“明智选择”运动的接触等问题。尽管持续进行宣传和医师外联工作，但在 2014 年至 2017 年期间，医师对运动的认识（从 21%增加到 25%）或医师报告与患者谈论避免低价值服务的困难程度（2014 年有 42%的人表示此类对话变得更加困难，2017 年有 46%的人表示如此）方面均无明显变化。建议采用的障碍包括医疗事故的担忧、患者的需求和满意度以及医师对减少不确定性的更多信息的渴望。应该采取多方面的干预措施，通过个性化教育、后续行动和反馈以及一致的财务激励措施来加强指导方针，以减少低价值服务的使用。
