The impact of the Choosing wisely (CW) campaign is debated as
recommendations alone may not modify physician behavior. The aim of this study was
to assess whether behavioral interventions with physician assessment and feedback
during quality circles (QCs) could reduce low-value services.
Pre-post quality improvement intervention with parallel comparison group involving outpatients
followed in a Swiss managed care network, including 700 general physicians (GP) and
150,000 adult patients. Interventions included performance feedback about low-value
activities and comparison with peers during QCs. We assessed individual physician
behavior and health care use from laboratory and insurance claims files between
August 1, 2016, through October 31, 2018. Main outcomes were the change in
prescription of three low value services six months before and six months after each
intervention: measurement of prostate specific antigen (PSA) and prescription rates of
proton pump inhibitor (PPI) and statins.
QC intervention with physician feedback and peer comparison resulted in lower rates of PPI prescription (pre-post mean prescriptions per GP 25.5 ± 23.7 vs 22.9 ± 21.4 , p-value<0.01; PSA measurement (6.5 ± 8.7 vs 5.3 ± 6.9 tests per GP, p<0.01; and statins (6.1 ± 6.8 vs 5.6 ± 5.4 prescriptions per GP, p<0.01). Changes in prescription of low-value services among GP who did not attend QCs were
not statistically significant over this time period.
Our results demonstrate a modest but statistically significant effect of QCs with educative feedback
in reducing low-value services in outpatients with low impact on coefficient of variation.