Re: Clinical Decisions Made in Primary Care Clinics Before and After Choosing Wisely?

摘要

To the Editor: Kost and Genoa demonstrated that physician adherence to guidelines for 5 low-value clinical decisions improved through educational interventions.1 They concluded that “primary care physicians respond to training and publicity in low-value care.” This intervention strategy decreased physician-initiated testing that provide little clinical value. In this way, the Choosing Wisely initiative may help to achieve the health care triple aim.2 However, the authors failed to explain why there were drastic differences in responses among the intervention groups. Of the 5 clinical decisions that were targeted, 2 groups (antibiotics for acute sinusitis, dual-energy X-ray absorptiometry for osteoporosis screening) improved in adherence markedly, and 3 groups (cervical cancer screening, heart disease screening, back pain imaging) did not change significantly. This disparity merits thoughtful discussion and a call for further research.