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

The British Journal of General Practice : the Journal of the Royal College of General Practitioners
Toshihiko TakadaLotty Hooft

Abstract

It is recognised that medical tests are overused in primary care; however, it is unclear how best to reduce their use. To identify which strategies are effective in reducing the use of low-value medical tests in primary care settings. Systematic review. 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. 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 t...Continue Reading

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