Relative importance and interactions of factors influencing low-value care provision: a factorial survey experiment among Swedish primary care physicians
Relative importance and interactions of factors influencing low-value care provision: a factorial survey experiment among Swedish primary care physicians
StatusVoR
Alternative title
Authors
Roczniewska, Marta
Augustsson, Hanna
Ingvarsson, Sara
Hedberg Rundgren, Emma
Szymański, Kamil
von Thiele Schwarz, Ulrica
Nilsen, Per
Hasson, Henna
Monograph
Monograph (alternative title)
Date
2025-08-18
Publisher
Journal title
BMJ Quality & Safety
Issue
9
Volume
34
Pages
Pages
570-579
ISSN
2044-5415
ISSN of series
Access date
2025-08-18
Abstract PL
Abstract EN
Background: Low-value care (LVC) describes practices that persist in healthcare, despite being ineffective, inefficient or causing harm. Several determinants for the provision of LVC have been identified, but understanding how these factors influence professionals’ decisions, individually and jointly, is a necessary next step to guide deimplementation. Methods: A factorial survey experiment was employed using vignettes that presented hypothetical medical scenarios among 593 Swedish primary care physicians. Each vignette varied systematically by factors such as patient age, patient request for the LVC, physician’s perception of this practice, practice cost to the primary care centre and time taken to deliver it. For each scenario, we measured the reported likelihood of providing the LVC. We collected information on the physician’s worry about missing a serious illness. Results: Patient requests and physicians’ positive perceptions of the practice were the factors that increased the reported likelihood of providing LVC the most (by 14 and 13 percentage points (pp), respectively). When the LVC was low in cost or not time-consuming, patient requests further boosted the likelihood of provision by 29 and 18 pp. In contrast, credible evidence against the LVC reduced the role of patient requests by 11 pp. Physicians’ fear of missing a serious illness was linked with higher reported probability of providing LVC, and the credibility of the evidence against the LVC reduced the role of this concern. Conclusions: The findings highlight that patient requests enhance the role of many determinants, while the credibility of evidence diminishes the impact of others. Overall, these findings point to the relevance of increased clinician knowledge about LVC, tools for patient communication and the use of decision support tools to reduce the uncertainty in decision-making.
Abstract other
Keywords PL
Keywords EN
Keywords other
Exhibition title
Place of exhibition (institution)
Exhibition curator
Type
License type
Funder
Time range from
Time range to
Contact person name
Related publication
Related publication
Grant/project name
Collections
Views
18Acquisition Date16.12.2025
Downloads
1Acquisition Date16.12.2025
Altmetrics©
Dimensions
Google Scholar
