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Table 6 Original research citations that evaluated the de-adoption of low-value clinical practicesa

From: Towards understanding the de-adoption of low-value clinical practices: a scoping review

Citation Study design Target condition Low-value practice Evidence guiding de-adoption Reason practice considered low-value Reduction in use of low-value practice Other notable results
Active change intervention facilitated de-adoption b      
Ross-Degnan et al. 1993 [29] Interrupted time series Arthritides NSAIDs, Zomepirac Case series Harmful Yes Increased prescription of other NSAIDs
Williams et al. 2006 [30] Interrupted time series Arthritides COX-2 inhibitors RCT Harmful Yes Safety concerns for rofecoxib interpreted as class effect
Thiebaud et al. 2006 [31] Cohort study Arthritides COX-2 inhibitors RCT Harmful Yes Greater decrease in COX-2 inhibitor use among patients with greater number of cardiovascular comorbidities
Barozzi and Tett 2007 [32] Interrupted time series Arthritides COX-2 inhibitors RCT Harmful Yes Safety concerns for rofecoxib interpreted as class effect; prescription of non-selective NSAIDs increased
Sun et al. 2007 [33] Interrupted time series Arthritides COX-2 inhibitors RCT Harmful Yes Significant increases in non-selective NSAID use after withdrawal of rofecoxib and valdecoxib
Setakis et al. 2008 [34] Before-and-after Arthritides COX-2 inhibitors RCT Harmful Yes After withdrawal of rofecoxib, remaining use of COX-2 inhibitors did not concentrate in patients with high gastrointestinal risk and low cardiovascular risk
Sukel et al. 2008 [35] Before-and-after Arthritides COX-2 inhibitors RCT Harmful Yes Safety concerns for rofecoxib interpreted as class effect
Hsiao et al. 2009 [36] Cohort Arthritides COX-2 inhibitors RCT Harmful Yes Safety concerns for rofecoxib interpreted as class effect
Stafford and Radley 2003 [37] Interrupted time series Obesity Fenfluramine and dexfenfluramine Case–control study Harmful Yes No change in practice after reports of adverse events. Market withdrawal of drug required to change practice
Krol et al. 2004 [27] Cluster RCT PPI use PPIs in those without indications for their continued use Clinical practice guideline Not reported Yes No recrudescence of symptomatology associated with original PPI prescription after its discontinuation
Roumie et al. 2004 [25] Interrupted time series Post-menopausal women HRT RCT Harmful Yes Greater rate of discontinuation of HRT after tailored de-adoption intervention compared to media release of results of WHI study
Kulawik et al. 2009 [28] Before-and-after End-stage renal disease Use of tunnelled hemodialysis catheters in patients with end-stage renal disease Cohort, quasi-experimental, and clinical practice guideline Harmful, not cost effective Yes Involvement of medical leader improved rate of reduction in catheter use
Sindby et al. 2011 [26] Before-and-after Coronary artery bypass surgery Blood transfusions Not reported Not reported Yes Not reported (conference abstract)
No intervention used to facilitate de-adoption c      
Austin et al. 2003 [99] Interrupted time series Post menopausal women HRT RCT Harmful Yes Unable to determine if decline in HRT use patient or physician-initiated
Lawton et al. 2003 [124] Survey Post menopausal women HRT RCT Harmful Yes Factors associated with stopping HRT included older age, use of combined HRT, longer duration of HRT
Haas et al. 2004 [118] Interrupted time series Post menopausal women HRT RCT Harmful Yes Greater decrease in HRT use after WHI study compared to Heart and Estrogen/progestin Replacement Study
Hersh et al. 2004 [103] Interrupted time series Post menopausal women HRT RCT Harmful Yes Response to publication of WHI study was rapid
Majumdar et al. 2004 [98] Interrupted time series Post menopausal women HRT RCT Harmful Yes Substantial decline in promotional spending for HRT after publication of WHI study
Huang et al. 2007 [122] Cohort Post menopausal women HRT RCT Harmful Yes Factors associated with reduction in use of HRT included higher patient education, and care at an academic institution
Majumdar et al. 2001 [97] Before-and-after Acute coronary syndrome Calcium channel blockers Lidocaine Case–control study; Systematic review Harmful Yes No difference in calcium channel blocker discontinuation according to physician specialty
Brunt et al. 2003 [120] Interrupted time series Hypertension Short acting calcium channel blockers Case–control study Harmful Yes Proportionate increase in other anti-hypertensive medication paralleled discontinuation of calcium channel blockers
Stafford et al. 2004 [96] Interrupted time series Hypertension Alpha-blockers RCT Harmful Yes Substantial decrease in office promotion expenditures for alpha-blockers following publication of ALLHAT trial
Xie et al. 2005 [95] Interrupted time series Hypertension Alpha-blockers RCT Harmful Yes Decrease in alpha-blockers associated with increase in other anti-hypertensive medications
Hauptman et al. 2006 [18] Interrupted time series Congestive heart failure Nesiritide Systematic review Harmful Yes Decrease in nesiritide use associated with increased use of inotropes
Atwater et al. 2009 [90] Before-and-after Coronary artery disease PCI RCT Lack of efficacy Yes Decrease in PCI and increase in medical therapy following COURAGE trial
Bonakdar tehrani and Howard 2011 [84] Before-and-after Coronary artery disease PCI RCT Lack of efficacy Yes PCI use decreased after COURAGE trial, however considerable number of patients with stable angina continued to receive PCI
Deyell et al. 2011 [89] Interrupted time series Coronary artery disease PCI RCT Lack of efficacy No No change in PCI after OAT trial or guideline revisions
Ahmed et al. 2011 [93] Interrupted time series Coronary artery disease PCI RCT Lack of efficacy Yes Decrease in PCI use was sustained up to 2 years after publication of COURAGE trial
Wiener and Welch 2007 [91] Interrupted time series Critical illness PAC RCT; Systematic review Lack of efficacy Yes PAC use began to decline after publication of large observational study (before publication of any RCTs)
Koo et al. 2011 [87] Interrupted time series Critical illness PAC RCT; Systematic review Lack of efficacy Yes Examined patient, physician, and unit-level predictors of PAC use
Gershengorn and Wunsch 2013 [128] Cohort Critical illness PAC RCT; Systematic review Lack of efficacy Yes Surgical patients continue to have high likelihood of PAC use
Murphy et al. 2013 [92] Cohort Critical illness Blood transfusions RCT Harmful Yes (higher volume hospitals only) Likelihood of receiving blood transfusion after publication of TRICC trial dependent on annualized intensive care unit patient volume
Duffy and Farley 1992 [105] Cohort Chronic obstructive pulmonary disease IPPB RCT Lack of efficacy Yes Hospital-level traits and models of funding technologies were associated with discontinuing IPPB
Smalley et al. 2000 [121] Before-and-after Gastric motility disorders Cisapride Case series; Warning letter from Food and Drug Administration Harmful No Cisapride use not effected by black-box US Food and Drug Administration warning regarding harmful effects
Howard et al. 2011 [101] Interrupted time series Breast cancer High dose chemotherapy/Hematopoietic cell transplants RCT Lack of efficacy and harmful Yes No association between hospital teaching status and participation in clinical trials, and decline in use of the low-value practice
Chamberlain et al. 2013 [56] Interrupted time series (1) Pregnant women with hepatitis (1) Caesarean section Clinical practice guideline (NICE ‘do not do’ recommendation) Lack of efficacy and harmful No “Do not do” recommendation reminders had no association with changes in clinical practice
(2) Infertile men and women (2) Fertility procedures
Kowalczyk et al. 2012 [82] Cohort Prostate cancer RRP Cohort study Not reported Yes Decrease in RRP was associated with an increase in RRP-related complications
Luetmer and Kallmes 2011 [88] Before-and-after Vertebral fracture Vertebroplasty RCT Lack of efficacy Yes Referrals for vertebroplasty decreased, however proportion of referrals undergoing the procedure increased
Ehrenstein et al. 2013 [94] Interrupted time series Diabetes mellitus Rosiglitazone Systematic review Cohort study Harmful Yes No significant change in markers of glycemic control after discontinuation of rosiglitazone
  1. aFive citations excluded from this table discussed, but did not actually evaluate the outcome of a de-adoption process [52, 59, 106, 123, 125]
  2. bCitations that employed a de-adoption intervention included:
  3. - Ross-Degnan et al. [29]: Market withdrawal of Zomepirac
  4. - Williams et al. [30], Thiebud et al. [31], Barozzi and Tett [32], Sun et al. [33], Setakis et al. [34], Sukel et al. [35], Hsiao et al. [36]: Market withdrawal of rofecoxib
  5. - Stafford and Radley [37]: Market withdrawal of fenfluramine and dexfenfluramine
  6. - Krol et al. [27]: Information leaflet with recommendations for reducing inappropriate PPI use sent to patients from general practice clinics
  7. - Roumie et al. [25]: Three-part intervention consisting of patient and provider education component and provider care component
  8. - Kulawik et al.,[28]: Catheter reduction toolkit (education on types of vascular access) employed in facilities with high catheter utilization rates
  9. - Sindby et al. [26]: Provider education, audit and feedback, and hospital-level guideline changes
  10. cAny observed de-adoption reflects the effect of passive diffusion of evidence of a practice’s ineffectiveness or harm
  11. COX-2 cyclo-oxygenase-2, HRT hormone replacement therapy, IPPB intermittent positive pressure breathing, NSAIDs non-steroidal anti-inflammatory drugs, PAC pulmonary artery catheter, PCI percutaneous coronary intervention, PPIs proton pump inhibitors, RRP retropubic radical prostatectomy, WHI Women’s Health Initiative