One of our largest Healthcare Corporations has used its house journal, the JAMA, to publish its findings on the stubborn disobedience by primary care individuals in obeying ‘guidelines’ for ‘choosing wisely.’
For this population-level analysis of 7 low-value services analyzed, changes were modest but showed a desirable decrease for 2 recommendations (imaging for headache, cardiac imaging for low-risk patients). The effect sizes were marginal, however, and although 4 of the 7 lists had statistically significant changes—unsurprising given the large sample size—the clinical significance is uncertain. These results suggest that additional interventions are necessary for wider implementation of Choosing Wisely recommendations.
The kicker is the very last sentence – when gentle approaches fail, it’s time to get out the iron fist.