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Research

Strategies to reduce the use of low-value medical tests in primary care: a systematic review

Toshihiko Takada, Pauline Heus, Sander van Doorn, Christiana A Naaktgeboren, Jan-Willem Weenink, Simone A van Dulmen and Lotty Hooft
British Journal of General Practice 2020; 70 (701): e858-e865. DOI: https://doi.org/10.3399/bjgp20X713693
Toshihiko Takada
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht.
Roles: Assistant professor
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Pauline Heus
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht; Cochrane Netherlands, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht.
Roles: Assistant professor
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Sander van Doorn
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht.
Roles: Assistant professor
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Christiana A Naaktgeboren
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht.
Roles: Assistant professor
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Jan-Willem Weenink
Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam.
Roles: Assistant professor
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Simone A van Dulmen
Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen.
Roles: Senior researcher
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Lotty Hooft
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht; Cochrane Netherlands, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht.
Roles: Associate professor
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Abstract

Background It is recognised that medical tests are overused in primary care; however, it is unclear how best to reduce their use.

Aim To identify which strategies are effective in reducing the use of low-value medical tests in primary care settings.

Design and setting Systematic review.

Method The databases MEDLINE, EMBASE, and Rx for Change were searched (January 1990 to November 2019) for randomised controlled trials (RCTs) that evaluated strategies to reduce the use of low-value medical tests in primary care settings. Two reviewers selected eligible RCTs, extracted data, and assessed their risk of bias.

Results Of the 16 RCTs included in the review, 11 reported a statistically significant reduction in the use of low-value medical tests. The median of the differences between the relative reductions in the intervention and control arms was 17% (interquartile range 12% to 24%). Strategies using reminders or audit/feedback showed larger reduction than those without these components (22% versus 14%, and 22% versus 13%, respectively) and patient-targeted strategies showed larger reductions than those not targeted at patients (51% versus 17%). Very few studies investigated the sustainability of the effect, adverse events, cost-effectiveness, or patient-reported outcomes related to reducing the use of low-value tests.

Conclusion This review indicates that it is possible to reduce the use of low-value medical tests in primary care, especially by using multiple components including reminders, audit/feedback, and patient-targeted interventions. To implement these strategies widely in primary care settings, more research is needed not only to investigate their effectiveness, but also to examine adverse events, cost-effectiveness, and patient-reported outcomes.

  • investigative techniques
  • medical overuse
  • medical tests
  • primary care
  • systematic review
  • unnecessary procedures
  • Received March 19, 2020.
  • Revision requested May 1, 2020.
  • Accepted June 3, 2020.
  • © British Journal of General Practice 2020
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British Journal of General Practice: 70 (701)
British Journal of General Practice
Vol. 70, Issue 701
December 2020
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Strategies to reduce the use of low-value medical tests in primary care: a systematic review
Toshihiko Takada, Pauline Heus, Sander van Doorn, Christiana A Naaktgeboren, Jan-Willem Weenink, Simone A van Dulmen, Lotty Hooft
British Journal of General Practice 2020; 70 (701): e858-e865. DOI: 10.3399/bjgp20X713693

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Strategies to reduce the use of low-value medical tests in primary care: a systematic review
Toshihiko Takada, Pauline Heus, Sander van Doorn, Christiana A Naaktgeboren, Jan-Willem Weenink, Simone A van Dulmen, Lotty Hooft
British Journal of General Practice 2020; 70 (701): e858-e865. DOI: 10.3399/bjgp20X713693
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Keywords

  • investigative techniques
  • medical overuse
  • medical tests
  • primary care
  • systematic review
  • unnecessary procedures

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Print ISSN: 0960-1643
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