Choosing Wisely: low value care as described by Swedish GPs

Staffan Svensson, Hálfdán Pétursson, Karin Mossberg, Sofia Zettermark, Andreas Thörneby, Minna Johansson, Jonas Sjögreen, Oskar Lindfors, David Gyll, Josabeth Hultberg, Jan Håkansson

Keywords: low value care, choosing wisely, general practice

Background:

A considerable fraction of health care activity does not contribute net health gains for patients. General practitioners are exposed to such low value care in many ways and it is a source of professional frustration. The Choosing Wisely movement aims to identify low value care and to reduce it through campaigns directed at health care professionals and the public.

Research questions:

Which health care activities do Swedish GPs think should be de-implemented?

Method:

A nationwide data gathering effort was organized by the Swedish Association of General Practice in 2023–2024, in order to collect proposals for an upcoming Choosing Wisely campaign. GPs and residents in general practice were invited to 3-hour workshops held by the authors. After an introductory presentation, participants worked in groups to identify five candidate activities for de-implementation. Participants were asked to motivate each proposal and suggest underlying drivers that kept the activity going in spite of its low value. They were also asked to suggest ways of measuring the outcome of efforts directed at decreasing the activity, as well as evidence of it being of low value.

Results:

A total of 18 workshops were organized, in 13 of the 21 Swedish regions. There were 115 groups with 6–10 participants each, contributing 739 candidates for low value care to be de-implemented. Out of these, 409 (55%) were motivated, 125 (17%) had reference to drivers, 89 (12%) came with a suggestion for evaluation and 38 (5%) pointed to some evidence. The proposals were categorized into the following overarching themes: administrative burdens, specific health care activities, general principles, and those related to clinical guidelines and health care routines.

Conclusions:

Swedish GPs contributed a wealth of suggestions for de-implementation, which is crucial for arriving at a Choosing Wisely campaign that adequately reflects their experience.

Points for discussion:

How could this data be used for creating higher value care in the future?

What type of analysis is reasonable given the extent of this material?

There is also a “positive” counterpart, “which health care activities should GPs do more of” – how could these replies be integrated in the analysis?

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