Author (year) | Country | Design | Number of patients included | Clinical setting | Low-value practice | Intervention | Control | Use of low-value practice with intervention | Use of low-value practice without intervention | Change in use of the low-value practice |
---|---|---|---|---|---|---|---|---|---|---|
Randomized clinical trials | ||||||||||
Macfarlane (2002) [28] | UK | Nested | 212 | Primary care | Antibiotics for acute bronchitis | Information leaflet on the natural course of lower respiratory symptoms and the advantage and disadvantages of antibiotics | General practitioner provided prompt card for informing patients that there is no indication for antibiotics | Proportion of patients who used antibiotics, 47% | Proportion of patients who used antibiotics, 62% | RR 0.76; 95% CI (0.59–0.97) |
Francis (2009) [29] | UK | Cluster | 558 | Primary care | Antibiotic prescribing | Interactive booklet on respiratory tract infections | Usual care | Proportion of patients prescribed antibiotics, 19.5% | Proportion of patients prescribed antibiotics, 40.8% | RR 0.48; 95% CI (0.36, 0.64) |
Legare (2012) [30] | Canada | Cluster | 181 | Primary care | Antibiotics for acute respiratory tract infections | Shared decision-making between patient and physicians | Usual care | Patients who used antibiotics following consultation, 27.2% | Patients who used antibiotics following consultation, 52.2% | RR 0.53; 95% CI (0.40, 0.70) |
Tannenbaum (2014) [31] | Canada | Cluster | 303 | Community pharmacy | Benzodiazepines for older adults | Booklet providing information about risks, a tapering protocol, and prompt to discuss with physician | Usual care | Proportion of patients who discontinued benzodiazepine use, 27.0% | Proportion of patients who discontinued benzodiazepine use, 4.5% | RR 0.76; 95% CI (0.69, 0.85) |
Schneiderman (2003) [32] | USA | Multi-center | 551 | Hospital | Non-beneficial life-sustaining treatments in the intensive care unit | Ethics consultations | Usual care | Mean (SD) days receiving ventilation, 6.52 (8.52) | Mean (SD) days receiving ventilation, 8.22 (11.16) | Absolute difference, 1.7 days; P = 0.03 |
Montgomery (2007) [33] | UK | Three-armed | 742 | Hospital | Non-indicated cesarean section | Information program: Information about probabilities of clinical outcomes Decision analysis: Decision tree recommended a “preferred option” based on women’s preferences and values | Usual care | Proportion of elective cesarean sections: information program, 49%; decision analysis, 41% | Proportion of elective cesarean sections, 50% | Information program: RR 0.95; 95% CI (0.79, 1.14) Decision analysis: RR 0.80; 95% CI (0.66, 0.98) |
Hess (2012) [34] | USA | Two-armed, parallel | 204 | Emergency department | Cardiac stress testing in patients at low risk for acute coronary syndrome | Decision aid to improve patient knowledge and engage in shared decision-making | Usual care | Proportion of patients who received stress testing within 30 days of ED visit, 75% | Proportion of patients who received stress testing within 30 days of ED visit, 91% | RR 0.81; 95% CI (0.72, 0.93) |
Hess (2016) [35] | USA | Multi-center | 898 | Emergency department | Cardiac stress testing in patients at low risk for acute coronary syndrome | Inform patients about their risk and options for care; shared decision aid | Usual care | Proportion of patients who received stress testing within 30 days of ED visit, 38.1% | Proportion of patients who received stress testing within 30 days of ED visit, 45.6% | RR 0.84; 95% CI (0.72, 0.98) |
Navaee (2015) | Iran | Two-armed, parallel | 67 | Hospital | Cesarean section in primiparous women | Role-playing session about the advantages and disadvantages of cesarean section | Usual care | Proportion of patients who had a c-section, 2.9% | Proportion of patients who had a c-section, 15.6% | RR 0.18; 95% CI (0.02–1.48) |
Non-randomized intervention studies | ||||||||||
Wheeler (2001) [36] | USA | Prospective observational study | 144 | Primary care | Antibiotic overuse | Educational videotape and written materials | No control group | Proportion of patients receiving antibiotic prescriptions, 4.2% | Proportion of patients receiving antibiotic prescriptions, 6.8% | RR 0.62; 95% CI (0.15, 2.49) |
Perz (2002) [37] | USA | Before-and-after* | NR | Primary care | Antibiotic overuse | Educational materials for parents of young children and the general public | Usual care | Percent change in antibiotic prescription rate from baseline per 100 person-years, − 19% | Percent change in antibiotic prescription rate from baseline per 100 person-years, − 8% | Intervention-attributable decline, 11%; 95% CI (8–14%) |
Dollman (2005) [38] | Australia | Before-and-after | ~ 20,000 | Primary care | Antibiotic use for upper respiratory tract infections, sinusitis, and otitis media | Pamphlets highlighting risks and benefits distributed to general practices and within the community | No control group | Defined daily dosages per 1000 population per day, 52.9 | Defined daily dosages per 1000 population per day, 77.1 | Overall reduction, 32%; p < 0.01 |
Gonzales (2005) [39] | USA | Non-randomized controlled trial* | 1144 | Primary care | Antibiotics for children with pharyngitis, antibiotics for adults with acute bronchitis | Educational materials mailed to households and available in physicians’ offices | Usual care | Proportion of patients prescribed antibiotics: adult, 36%; child, 30% | Proportion of patients prescribed antibiotics: adult, 60%; child, 34% | Adult: RR 0.60; 95% CI (0.51, 0.70) Child: RR 0.88; 95% CI (0.65, 1.18) |
Ashe (2006) [40] | USA | Before-and-after | 720 | Primary care | Antibiotic overuse | Educational waiting room poster in physicians’ offices | Historical controls; usual care | Proportion of patients treated with antibiotics, 48.3% | Proportion of patients treated with antibiotics, 44.3% | RR 1.09; 95% CI (0.91, 1.31) |
Gonzales (2008) [41] | USA | Non-randomized controlled trial | 992 | Primary care | Antibiotic overuse | Media campaign | Counties that did not receive a media campaign | Net antibiotic prescriptions per 1000 persons compared to comparison community (12 months post-intervention), − 5 | Net antibiotic prescriptions per 1000 persons compared to control community (10 months pre-intervention), −1 | 8.8% net decrease in managed care-associated antibiotic dispenses per 1000 members; P = 0.03 |
Hemo (2009) [42] | Israel | Prospective observational study* | 84,979 | Not specified | Antibiotic use for upper respiratory tract infection, otitis media, pharyngitis | Media campaign | No control group | Post-campaign period vs. baseline: URI OR 0.749 (0.694, 0.808); otitis media OR 0.652 (0.591, 0.718); pharyngitis OR 0.931 (0.890, 0.973) | Pre-campaign period vs. baseline: URI OR 0.962 (0.891, 1.039); otitis media OR 0.970 (0.874, 1.076); pharyngitis OR 0.968 (0.929, 1.009) | |
Morgan (2002) [43] | UK | Before-and-after | 242 | Primary care | Long-term use of benzodiazepines | Patient letter explaining risks, encouraging a reduction in intake, and prompt to contact physician for discussion | No control group | Mean defined daily dosages/patient, 283.0 | Mean defined daily dosages/patient, 336.6 | Absolute difference, 53.6; P < 0.001 |
Simpson (2010) [44] | USA | Before-and-after | 531 | Hospital | Elective labor induction | Educational classes on elective induction risk | No educational classes | Proportion of patients who received elective induction, 27.9% | Proportion of patients who received elective induction, 37% | RR 0.75; 95% CI (0.58, 0.96) |
Engineer (2018) [45] | USA | Quality improvement project | 176 | Emergency department | Computed tomography for mild head injury | Electronic tool that involved a structured discussion between providers and caregivers | No control group | Proportion of patients who received head CT, 22.0% | Baseline head CT utilization in the pediatric ED population, 62.7% | RR 0.35; 95% CI (0.26, 0.47) |
Arterburn (2006) | USA | Before-and-after | 9515 | Hospital | Unnecessary surgery for knee and hip osteoarthritis | Patient decision aids in DVD, website, and booklet format | No control group | Total hip replacement per 180 person-days, 0.34 Total knee replacement per 180 person-days, 0.09 | Total hip replacement per 180 person-days, 0.46 Total knee replacement per 180 person-days, 0.16 | Hip replacement relative rate, 0.74, P < 0.01 Knee replacement relative rate, 0.62, P < 0.01 |
Jerardi (2013) | USA | Quality improvement project | 224 | Hospital | Voiding cystourethrogram (VCUG) in children with first UTI with normal renal and bladder ultrasound (RBUS) | Educational materials and information sheets for patients and families | No control group | Proportion of patients with normal RBUS who received VCUG: 25.4% | Proportion of patients with normal RBUS who received VCUG: 84.9% | RR 0.29; 95% CI (0.17, 0.51) |
Pugel (2018) | USA | Quality improvement project | Hospital | Complete blood counts (CBCs), electrocardiograms (EKGs) as routine screening tests in physical examination visits, age-inappropriate dual-energy absorptiometry (DEXA) scans, imaging for uncomplicated headache | Patient-targeted materials produced by Consumer Reports, including exam room posters, patient education materials in waiting areas and exam rooms | No control group | CBCs, 3.16%; EKGs, 0.33%; DEXA scans, 2.02%; imaging for uncomplicated headache, 6.88% | CBCs, 42.7%; EKGs, 15.9%; DEXA scans, 25.4%; imaging for uncomplicated headache, 10.8% | Absolute difference (95% CI): CBCs 39.54% (39.0–40.0); EKGs 15.57% (15.1–15.8); DEXA scans 23.38% (22.5–24.5); imaging for uncomplicated headache 3.92% (3.3–4.6) |