Preferences and beliefs of Dutch orthopaedic surgeons and patients reduce the implementation of “Choosing Wisely” recommendations in degenerative knee disease

Rietbergen, T.J.F.; Diercks, R. L.; Anker-van der Wel, I.; van den Akker-van Marle, M. E.; Lopuhaä, N.; Janssen, R. P.A.; van der Linden-van der Zwaag, H. M.J.; Nelissen, R.G.H.H.; Marang-van de Mheen, P.J.; van Bodegom-Vos, Leti

Preferences and beliefs of Dutch orthopaedic surgeons and patients reduce the implementation of “Choosing Wisely” recommendations in degenerative knee disease

Journal article (2020)

Authors

T.J.F. Rietbergen Leiden University Medical Center

R. L. Diercks University Medical Center Groningen

I. Anker-van der Wel Leiden University Medical Center

M. E. van den Akker-van Marle Leiden University Medical Center

N. Lopuhaä ReumaNederland

R. P.A. Janssen Maxima Medical Center, Veldhoven

H. M.J. van der Linden-van der Zwaag Leiden University Medical Center

R.G.H.H. Nelissen Leiden University Medical Center

P.J. Marang-van de Mheen Leiden University Medical Center

Leti van Bodegom-Vos Leiden University Medical Center

Affiliation

External organisation

Magnetic resonance imaging De-implementation Choosing Wisely Degenerative knee disease Knee arthroscopy Barriers and facilitators

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Published Date

2020

Language

English

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Abstract

Purpose: The purpose of this study was to assess which factors were associated with the implementation of “Choosing Wisely” recommendations to refrain from routine MRI and arthroscopy use in degenerative knee disease. Methods: Cross-sectional surveys were sent to 123 patients (response rate 95%) and 413 orthopaedic surgeons (response rate 62%) fulfilling the inclusion criteria. Univariate and multivariate logistic regression analyses were used to identify factors associated with implementation of “Choosing Wisely” recommendations. Results: Factors reducing implementation of the MRI recommendation among patients included explanation of added value by an orthopaedic surgeon [OR 0.18 (95% CI 0.07–0.47)] and patient preference for MRI [OR 0.27 (95% CI 0.08–0.92)]. Factors reducing implementation among orthopaedic surgeons were higher valuation of own MRI experience than existing evidence [OR 0.41 (95% CI 0.19–0.88)] and higher estimated patients’ knowledge to participate in shared decision-making [OR 0.38 (95% CI 0.17–0.88)]. Factors reducing implementation of the arthroscopy recommendation among patients were orthopaedic surgeons’ preferences for an arthroscopy [OR 0.03 (95% CI 0.00–0.22)] and positive experiences with arthroscopy of friends/family [OR 0.03 (95% CI 0.00–0.39)]. Factors reducing implementation among orthopaedic surgeons were higher valuation of own arthroscopy experience than existing evidence [OR 0.17 (95% CI 0.07–0.46)] and belief in the added value [OR 0.28 (95% CI 0.10–0.81)]. Conclusions: Implementation of “Choosing Wisely” recommendations in degenerative knee disease can be improved by strategies to change clinician beliefs about the added value of MRIs and arthroscopies, and by patient-directed strategies addressing patient preferences and underlying beliefs for added value of MRI and arthroscopies resulting from experiences of people in their environment. Level of evidence: IV.