From: Determinants of the de-implementation of low-value care: a multi-method study
Stakeholders | Frequently Cited Barriers | Frequently Cited Facilitators |
---|---|---|
Patients | • Patient demands and preferences •Challenges with stakeholder support | • Stakeholder involvement • Shared decision-making • Patient awareness of low-value care |
Clinicians | • Lack of credible evidence • Disconnect between training and evidence • Fear of malpractice • Entrenched norms and clinicians’ resistance to change • Challenges with stakeholder support • Model of physician reimbursement | • Stakeholder involvement • Availability of credible evidence • Shared decision-making • Audit and feedback • Interactive clinician education • Clinical decision support |
Decision-makers | • Lack of credible evidence • Lack of resources for de-adoption initiatives • Lack of data for identifying low-value care • Challenges with stakeholder support • Model of physician reimbursement • Lack of criteria for identifying low-value practices | • Stakeholder involvement • Availability of credible evidence • Cost-saving opportunity • Prioritized low-value practices • Established and credible assessment criteria to identify low-value care |
Researchers | • Lack of credible evidence • Lack of resources for de-adoption initiatives • Lack of data for identifying low-value care • Challenges with stakeholder support • Lack of criteria for identifying low-value practices | • Stakeholder involvement • Availability of credible evidence • Prioritized low-value practices • Established and credible assessment criteria to identify low-value care |