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- Title
Emergency Physician Knowledge, Attitudes, and Behavior Regarding ACEP's Choosing Wisely Recommendations: A Survey Study.
- Authors
Lin, Michelle P.; Nguyen, Thomas; Probst, Marc A.; Richardson, Lynne D.; Schuur, Jeremiah D.; Pines, Jesse M.
- Abstract
Objective In 2013, the American College of Emergency Physicians joined the Choosing Wisely campaign; however, its impact on emergency physician behavior is unknown. We assessed knowledge, attitudes, and self-reported behaviors regarding the Choosing Wisely recommendations. Methods We performed a cross-sectional survey of emergency physicians at a national meeting. We approached 819 physicians; 765 (93.4%) completed the survey. Results As a result of the Choosing Wisely campaign, most respondents (64.5%) felt more comfortable discussing low-value services with patients, 54.5% reported reducing utilization, and 52.5% were aware of local efforts to promote the campaign. A majority (62.97%) of respondents were able to identify at least four of five recommendations. The most prevalent low-value practices were computed tomography ( CT) brain for minor head injury (29.9%) and antibiotics for acute sinusitis (26.9%). Few respondents reported performing lumbar radiograph for nontraumatic low back pain (7.8%) and Foley catheter for patients who can void (5.6%). Respondents reported patient/family expectations as the most important reason for ordering antibiotics for sinusitis (68%) and imaging for low back pain (56.8%). However, concern for serious diagnosis was the most important reason for performing CT chest for patients with normal D-dimer (49.7%) and CT abdomen for recurrent uncomplicated renal colic (42.5%). A minority (3.8% to 26.7%) of respondents identified malpractice risk as the primary reason for performing low-value services. Conclusions Despite familiarity with Choosing Wisely, many emergency physicians report performing low-value services. Primary reasons for low-value services differ: antibiotic prescribing was driven by patient/family expectations, while concern for serious diagnosis influenced advanced diagnostic imaging. Greater efforts are needed to promote effective dissemination and implementation; such efforts may be targeted based on differing reasons for low-value services.
- Subjects
ANTIBIOTICS; AMERICAN College of Emergency Physicians; BRAIN injuries; COMPUTED tomography; EMERGENCY medical services; MALPRACTICE; SELF-evaluation; SINUSITIS; SURVEYS; DECISION making in clinical medicine; CROSS-sectional method; HEALTH literacy; PHYSICIANS' attitudes
- Publication
Academic Emergency Medicine, 2017, Vol 24, Issue 6, p668
- ISSN
1069-6563
- Publication type
Article
- DOI
10.1111/acem.13167