• Michael Grover, Neena Abraham, Yu-Hui Chang, and Jon Tilburt.
• From the Department of Family Medicine, Mayo Clinic, Scottsdale, AZ (MG); the Division of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale (NA); the Division of Biostatistics, Mayo Clinic, Scottsdale (Y-HC); and Division of General Internal Medicine, Mayo Clinic, Rochester, MN (JT). grover.michael@mayo.edu.
• J Am Board Fam Med. 2016 Nov 12; 29 (6): 785-792.

PurposeChoosing WiselyTM engaged medical specialties, creating "top 5 lists" of low-value services. We describe primary care physicians' (PCPs') self-reported use of these services and perceived barriers to guideline adherence. We quantify physician cost consciousness and determine associations with use.MethodsPCP attendees of a continuing medical education conference completed a survey. For each Family Medicine Choosing Wisely behavior, participants reported clinical adherence. Likert scale items assessed perceived barriers. Low-value service frequency was the dependent variable. A validated Cost Consciousness Scale created the predictor variable. We hypothesized that participants with greater cost consciousness would report less frequent use of low-value services.ResultsOf 199 PCP attendees, 143 (72%) participated. Papanicolaou test after hysterectomy was performed least (0.2 mean services performed/10 patients). Provider knowledge of sinusitis treatment guidelines was greatest but provided most frequently (3.9 mean services performed/10 patients). Practice related barriers were perceived most frequently for adhering to sinusitis treatment guidelines. Attitudinal barriers were greatest for avoiding osteoporosis screening in low risk patients. Greater cost consciousness was associated with less use of low-value services (P = .03), greater knowledge of guidelines (P = .001), and fewer perceived attitudinal and practice behavior-related barriers (P < .001 for each). Greater knowledge of guidelines was not associated with less use of low-value services (P = .58). Familiarity with Choosing Wisely was associated with both greater cost consciousness (P = .004) and less use of low-value services (P = .03).ConclusionsGreater PCP cost consciousness was associated with less use of low-value services. Interventions to decrease perceived barriers and increase cost consciousness, perhaps by increasing awareness of Choosing Wisely, may translate into improved performance.© Copyright 2016 by the American Board of Family Medicine.

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