Preferences and beliefs of Dutch orthopaedic surgeons and patients reduce the implementation of "Choosing Wisely" recommendations in degenerative knee disease.

Autor: Rietbergen T; Department of Biomedical Data Sciences, Section Medical Decision Making, Leiden University Medical Center, Postzone J10-s, P.O. Box 9600, 2300 RC, Leiden, The Netherlands., Diercks RL; Department of Orthopaedics, University Medical Center Groningen, Groningen, The Netherlands., Anker-van der Wel I; Department of Biomedical Data Sciences, Section Medical Decision Making, Leiden University Medical Center, Postzone J10-s, P.O. Box 9600, 2300 RC, Leiden, The Netherlands., van den Akker-van Marle ME; Department of Biomedical Data Sciences, Section Medical Decision Making, Leiden University Medical Center, Postzone J10-s, P.O. Box 9600, 2300 RC, Leiden, The Netherlands., Lopuhaä N; ReumaNederland, Amsterdam, The Netherlands., Janssen RPA; Department of Orthopaedics, Máxima Medical Center, Eindhoven, The Netherlands., van der Linden-van der Zwaag HMJ; Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands., Nelissen RGHH; Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands., Marang-van de Mheen PJ; Department of Biomedical Data Sciences, Section Medical Decision Making, Leiden University Medical Center, Postzone J10-s, P.O. Box 9600, 2300 RC, Leiden, The Netherlands., van Bodegom-Vos L; Department of Biomedical Data Sciences, Section Medical Decision Making, Leiden University Medical Center, Postzone J10-s, P.O. Box 9600, 2300 RC, Leiden, The Netherlands. l.vanbodegom-vos@lumc.nl.
Jazyk: angličtina
Zdroj: Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA [Knee Surg Sports Traumatol Arthrosc] 2020 Oct; Vol. 28 (10), pp. 3101-3117. Date of Electronic Publication: 2019 Sep 25.
DOI: 10.1007/s00167-019-05708-8
Abstrakt: Purpose: The purpose of this study was to assess which factors were associated with the implementation of "Choosing Wisely" recommendations to refrain from routine MRI and arthroscopy use in degenerative knee disease.
Methods: Cross-sectional surveys were sent to 123 patients (response rate 95%) and 413 orthopaedic surgeons (response rate 62%) fulfilling the inclusion criteria. Univariate and multivariate logistic regression analyses were used to identify factors associated with implementation of "Choosing Wisely" recommendations.
Results: Factors reducing implementation of the MRI recommendation among patients included explanation of added value by an orthopaedic surgeon [OR 0.18 (95% CI 0.07-0.47)] and patient preference for MRI [OR 0.27 (95% CI 0.08-0.92)]. Factors reducing implementation among orthopaedic surgeons were higher valuation of own MRI experience than existing evidence [OR 0.41 (95% CI 0.19-0.88)] and higher estimated patients' knowledge to participate in shared decision-making [OR 0.38 (95% CI 0.17-0.88)]. Factors reducing implementation of the arthroscopy recommendation among patients were orthopaedic surgeons' preferences for an arthroscopy [OR 0.03 (95% CI 0.00-0.22)] and positive experiences with arthroscopy of friends/family [OR 0.03 (95% CI 0.00-0.39)]. Factors reducing implementation among orthopaedic surgeons were higher valuation of own arthroscopy experience than existing evidence [OR 0.17 (95% CI 0.07-0.46)] and belief in the added value [OR 0.28 (95% CI 0.10-0.81)].
Conclusions: Implementation of "Choosing Wisely" recommendations in degenerative knee disease can be improved by strategies to change clinician beliefs about the added value of MRIs and arthroscopies, and by patient-directed strategies addressing patient preferences and underlying beliefs for added value of MRI and arthroscopies resulting from experiences of people in their environment.
Level of Evidence: IV.
Databáze: MEDLINE
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