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

T Rietbergen; R L Diercks; I Anker-van der Wel; M E van den Akker-van Marle; N Lopuhaä; R P A Janssen; H M J van der Linden-van der Zwaag; R G H H Nelissen; P J Marang-van de Mheen; L van Bodegom-Vos

doi:10.1007/s00167-019-05708-8

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

Knee Surg Sports Traumatol Arthrosc. 2020 Oct;28(10):3101-3117. doi: 10.1007/s00167-019-05708-8. Epub 2019 Sep 25.

Affiliations

¹ 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.
² Department of Orthopaedics, University Medical Center Groningen, Groningen, The Netherlands.
³ ReumaNederland, Amsterdam, The Netherlands.
⁴ Department of Orthopaedics, Máxima Medical Center, Eindhoven, The Netherlands.
⁵ Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands.
⁶ 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.

Abstract

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.

Keywords: Barriers and facilitators; Choosing Wisely; De-implementation; Degenerative knee disease; Knee arthroscopy; Magnetic resonance imaging.

MeSH terms

Aged
Arthroscopy / psychology*
Cross-Sectional Studies
Female
Guideline Adherence
Humans
Knee Joint / diagnostic imaging*
Knee Joint / surgery
Magnetic Resonance Imaging / psychology*
Male
Middle Aged
Orthopedic Surgeons / psychology*
Patient Preference
Unnecessary Procedures / psychology*

Grants and funding

8392010022/ZonMw