Abstract
BackgroundDespite efforts by professional societies to reduce low value care, many reports indicate that unnecessary tests, such as nuclear myocardial perfusion imaging (MPI), are commonly used in contemporary practice. The degree to which lack of awareness and professional liability concerns drive these behaviors warrants further study. We sought to investigate patient and provider perceptions about MPI in asymptomatic patients, the Choosing Wisely (CW) campaign, and professional liability concerns.MethodsWe administered an anonymous, paper-based survey with both discrete and open-response queries to subjects in multiple outpatient settings at our facilities. The survey was completed by 456 respondents including 342 patients and 114 physicians and advanced practice providers between May and August 2014. Our outcome was to compare patient and provider perceptions about MPI in asymptomatic patients and related factors.ResultsPatients were more likely than providers to report that MPI was justified for asymptomatic patients (e.g. asymptomatic with family history of heart disease 75% versus 9.2%, p < 0.0001). In free responses to the question “What would be an inappropriate reason for MPI?” many responses echoed the goals of CW (for example, “If you don’t have symptoms”, “If the test is too risky”, “For screening or in asymptomatic patients”). A minority of providers were aware of CW while even fewer patients were aware (37.2% versus 2.7%, p < 0.0001). Over one third of providers (38.9%) admitted to ordering MPI out of concern for professional liability including 48.3% of VA affiliated providers.ConclusionsWhile some patients and providers are aware of the low value of MPI in patients without symptoms, others are enthusiastic to use it for a variety of scenarios. Concerns about professional liability likely contribute, even in the VA setting. Awareness of the Choosing Wisely campaign is low in both groups.
Highlights
Despite efforts by professional societies to reduce low value care, many reports indicate that unnecessary tests, such as nuclear myocardial perfusion imaging (MPI), are commonly used in contemporary practice
A variety of initiatives have been created by the medical profession to curb unnecessary spending, such as the Choosing Wisely (CW) campaign
Survey questionnaire We developed and administered an anonymous survey to patients who have had MPI or had one ordered for them in primary care clinics, cardiology clinics, and nuclear medicine laboratories at both our academic medical center and affiliated Veterans Affairs (VA) medical center
Summary
Despite efforts by professional societies to reduce low value care, many reports indicate that unnecessary tests, such as nuclear myocardial perfusion imaging (MPI), are commonly used in contemporary practice. A variety of initiatives have been created by the medical profession to curb unnecessary spending, such as the Choosing Wisely (CW) campaign. This initiative was started by the American Board of Internal Medicine Foundation (ABIM) and asked medical societies to identify five things that patients and physicians should question. High rates of unnecessary MPI testing places burden on the medical system while exposing patients to unwarranted risks. In another initiative to reduce unnecessary and wasteful testing, professional societies have developed Appropriate Use Criteria (AUC) to assist doctors in deciding which patients may benefit from MPI in common clinical scenarios [4]
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