RT Journal Article
SR Electronic
T1 Strategies to reduce the use of low-value medical tests in primary care: a systematic review
JF British Journal of General Practice
JO Br J Gen Pract
FD British Journal of General Practice
SP bjgp20X713693
DO 10.3399/bjgp20X713693
A1 Toshihiko Takada
A1 Pauline Heus
A1 Sander van Doorn
A1 Christiana A Naaktgeboren
A1 Jan-Willem Weenink
A1 Simone A van Dulmen
A1 Lotty Hooft
YR 2020
UL http://bjgp.org/content/early/2020/11/16/bjgp20X713693.abstract
AB 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.