Abstract
Background: PCPs need effective communication strategies to address patient requests for low-value testing while sustaining patient-provider partnerships. Watchful waiting - allowing a negotiated period of time to pass before making a firm testing decision - shows promise as a tool for addressing patient requests for low-value testing. Methods: Observational analysis of data from a randomized controlled trial of a communication intervention designed to boost patient-centeredness and reduce low-value test ordering among 61 resident primary care physicians. Intervention effectiveness was assessed during follow-up encounters of unannounced standardized patients (SPs) who requested low-value tests. We examined associations between five physician counseling behaviors and overall patient-centeredness (Measure of Patient-Centered Communication) and requested test ordering. Results: During 155 SP encounters, residents most commonly used reassurance (96% of encounters), evidence-based recommendations (97%), and watchful waiting (68 %). Resident advice to pursue watchful waiting was associated with 39% lower likelihood of test ordering (adjusted marginal effect of -38.6% [95% CI -43.6 to -33.6]). When all communication behaviors were examined together, only watchful waiting was significantly associated with test ordering (marginal effect of -38% [95% CI -44.3% to -31.7%]). Overall patient-centeredness was not associated with lowvalue testing. Conclusion: Resident physician counseling to pursue watchful waiting was associated with less ordering of requested low-value diagnostic tests, while overall patient-centeredness was not.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 710-717 |
| Number of pages | 8 |
| Journal | Journal of the American Board of Family Medicine |
| Volume | 29 |
| Issue number | 6 |
| DOIs | |
| State | Published - Nov 1 2016 |
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Keywords
- Communication
- Counseling
- Diagnostic tests
- Follow-up studies
- Physical examination
- Physicians
- Primary care
- Probability
- Risk
- Routine
- Watchful waiting
ASJC Scopus subject areas
- Public Health, Environmental and Occupational Health
- Family Practice
Cite this
Watchful waiting strategy may reduce low-value diagnostic testing. / May, Larissa S; Franks, Peter; Jerant, Anthony F; Fenton, Joshua J.
In: Journal of the American Board of Family Medicine, Vol. 29, No. 6, 01.11.2016, p. 710-717.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Watchful waiting strategy may reduce low-value diagnostic testing
AU - May, Larissa S
AU - Franks, Peter
AU - Jerant, Anthony F
AU - Fenton, Joshua J
PY - 2016/11/1
Y1 - 2016/11/1
N2 - Background: PCPs need effective communication strategies to address patient requests for low-value testing while sustaining patient-provider partnerships. Watchful waiting - allowing a negotiated period of time to pass before making a firm testing decision - shows promise as a tool for addressing patient requests for low-value testing. Methods: Observational analysis of data from a randomized controlled trial of a communication intervention designed to boost patient-centeredness and reduce low-value test ordering among 61 resident primary care physicians. Intervention effectiveness was assessed during follow-up encounters of unannounced standardized patients (SPs) who requested low-value tests. We examined associations between five physician counseling behaviors and overall patient-centeredness (Measure of Patient-Centered Communication) and requested test ordering. Results: During 155 SP encounters, residents most commonly used reassurance (96% of encounters), evidence-based recommendations (97%), and watchful waiting (68 %). Resident advice to pursue watchful waiting was associated with 39% lower likelihood of test ordering (adjusted marginal effect of -38.6% [95% CI -43.6 to -33.6]). When all communication behaviors were examined together, only watchful waiting was significantly associated with test ordering (marginal effect of -38% [95% CI -44.3% to -31.7%]). Overall patient-centeredness was not associated with lowvalue testing. Conclusion: Resident physician counseling to pursue watchful waiting was associated with less ordering of requested low-value diagnostic tests, while overall patient-centeredness was not.
AB - Background: PCPs need effective communication strategies to address patient requests for low-value testing while sustaining patient-provider partnerships. Watchful waiting - allowing a negotiated period of time to pass before making a firm testing decision - shows promise as a tool for addressing patient requests for low-value testing. Methods: Observational analysis of data from a randomized controlled trial of a communication intervention designed to boost patient-centeredness and reduce low-value test ordering among 61 resident primary care physicians. Intervention effectiveness was assessed during follow-up encounters of unannounced standardized patients (SPs) who requested low-value tests. We examined associations between five physician counseling behaviors and overall patient-centeredness (Measure of Patient-Centered Communication) and requested test ordering. Results: During 155 SP encounters, residents most commonly used reassurance (96% of encounters), evidence-based recommendations (97%), and watchful waiting (68 %). Resident advice to pursue watchful waiting was associated with 39% lower likelihood of test ordering (adjusted marginal effect of -38.6% [95% CI -43.6 to -33.6]). When all communication behaviors were examined together, only watchful waiting was significantly associated with test ordering (marginal effect of -38% [95% CI -44.3% to -31.7%]). Overall patient-centeredness was not associated with lowvalue testing. Conclusion: Resident physician counseling to pursue watchful waiting was associated with less ordering of requested low-value diagnostic tests, while overall patient-centeredness was not.
KW - Communication
KW - Counseling
KW - Diagnostic tests
KW - Follow-up studies
KW - Physical examination
KW - Physicians
KW - Primary care
KW - Probability
KW - Risk
KW - Routine
KW - Watchful waiting
UR - http://www.scopus.com/inward/record.url?scp=84995551052&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84995551052&partnerID=8YFLogxK
U2 - 10.3122/jabfm.2016.06.160056
DO - 10.3122/jabfm.2016.06.160056
M3 - Article
C2 - 28076254
AN - SCOPUS:84995551052
VL - 29
SP - 710
EP - 717
JO - Journal of the American Board of Family Medicine
JF - Journal of the American Board of Family Medicine
SN - 1557-2625
IS - 6
ER -