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

Niven, Daniel J.; Mrklas, Kelly J.; Holodinsky, Jessalyn K.; Straus, Sharon E.; Hemmelgarn, Brenda R.; Jeffs, Lianne P.; Stelfox, Henry Thomas

doi:10.1186/s12916-015-0488-z

Table 6 Original research citations that evaluated the de-adoption of low-value clinical practices^a

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
Chamberlain et al. 2013 [56]	Interrupted time series	(2) Infertile men and women	(2) Fertility procedures		Lack of efficacy and harmful	No
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

^aFive citations excluded from this table discussed, but did not actually evaluate the outcome of a de-adoption process [52, 59, 106, 123, 125]
^bCitations that employed a de-adoption intervention included:
- Ross-Degnan et al. [29]: Market withdrawal of Zomepirac
- 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
- Stafford and Radley [37]: Market withdrawal of fenfluramine and dexfenfluramine
- Krol et al. [27]: Information leaflet with recommendations for reducing inappropriate PPI use sent to patients from general practice clinics
- Roumie et al. [25]: Three-part intervention consisting of patient and provider education component and provider care component
- Kulawik et al.,[28]: Catheter reduction toolkit (education on types of vascular access) employed in facilities with high catheter utilization rates
- Sindby et al. [26]: Provider education, audit and feedback, and hospital-level guideline changes
^cAny observed de-adoption reflects the effect of passive diffusion of evidence of a practice’s ineffectiveness or harm
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

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ISSN: 1741-7015

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