Physician Characteristics Associated With Ordering 4 Low-Value Screening Tests in Primary Care

Importance: Efforts to reduce low-value tests and treatments in primary care are often ineffective. These efforts typically target physicians broadly, most of whom order low-value care infrequently. Objectives: To measure physician-level use rates of 4 low-value screening tests in primary care to investigate the presence and characteristics of primary care physicians who frequently order low-value care. Design, Setting, and Participants: A retrospective cohort study was conducted using administrative health care claims collected between April 1, 2012, and March 31, 2016, in Ontario, Canada. This study measured use of 4 low-value screening tests-repeated dual-energy x-ray absorptiometry (DXA) scans, electrocardiograms (ECGs), Papanicolaou (Pap) tests, and chest radiographs (CXRs)-among low-risk outpatients rostered to a common cohort of primary care physicians. Exposures: Physician sex, years since medical school graduation, and primary care model. Main Outcomes and Measures: This study measured the number of tests to which a given physician ranked in the top quintile by ordering rate. The resulting cross-test score (range, 0-4) reflects a physician's propensity to order low-value care across screening tests. Physicians were then dichotomized into infrequent or isolated frequent users (score, 0 or 1, respectively) or generalized frequent users for 2 or more tests (score, ≥2). Results: The final sample consisted of 2394 primary care physicians (mean [SD] age, 51.3 [10.0] years; 50.2% female), who were predominantly Canadian medical school graduates (1701 [71.1%]), far removed from medical school graduation (median, 25.3 years; interquartile range, 17.3-32.3 years), and reimbursed via fee-for-service in a family health group (1130 [47.2%]), far removed from medical school graduation (median, 25.3 years; interquartile range, 17.3-32.3 years), and reimbursed via fee-for-service in a family health group (1130 [47.2%). They ordered 302 509 low-value screening tests (74 167 DXA scans, 179 855 ECGs, 19 906 Pap tests, and 28 581 CXRs) after 3 428 557 ordering opportunities. Within the cohort, generalized frequent users represented 18.4% (441 of 2394) of physicians but ordered 39.2% (118 665 of 302 509) of all low-value screening tests. Physicians who were male (odds ratio, 1.29; 95% CI, 1.01-1.64), further removed from medical school graduation (odds ratio, 1.03; 95% CI, 1.02-1.04), or in an enhanced fee-for-service payment model (family health group) vs a capitated payment model (family health team) (odds ratio, 2.04; 95% CI, 1.42-2.94) had increased odds of being generalized frequent users. Conclusions and Relevance: This study identified a group of primary care physicians who frequently ordered low-value screening tests. Tailoring future interventions to these generalized frequent users might be an effective approach to reducing low-value care

Effectiveness of a smartphone application for weight loss compared with usual care in overweight primary care patients: a randomized, controlled trial.

BackgroundMany smartphone applications (apps) for weight loss are available, but little is known about their effectiveness.ObjectiveTo evaluate the effect of introducing primary care patients to a free smartphone app for weight loss.DesignRandomized, controlled trial. (ClinicalTrials.gov: NCT01650337).Setting2 academic primary care clinics.Patients212 primary care patients with body mass index of 25 kg/m2 or greater.Intervention6 months of usual care without (n = 107) or with (n = 105) assistance in downloading the MyFitnessPal app (MyFitnessPal).MeasurementsWeight loss at 6 months (primary outcome) and changes in systolic blood pressure and behaviors, frequency of app use, and satisfaction (secondary outcomes).ResultsAfter 6 months, weight change was minimal, with no difference between groups (mean between-group difference, -0.30 kg [95% CI, -1.50 to 0.95 kg]; P = 0.63). Change in systolic blood pressure also did not differ between groups (mean between-group difference, -1.7 mm Hg [CI, -7.1 to 3.8 mm Hg]; P = 0.55). Compared with patients in the control group, those in the intervention group increased use of a personal calorie goal (mean between-group difference, 2.0 d/wk [CI, 1.1 to 2.9 d/wk]; P < 0.001), although other self-reported behaviors did not differ between groups. Most users reported high satisfaction with MyFitnessPal, but logins decreased sharply after the first month.LimitationsDespite being blinded to the name of the app, 14 control group participants (13%) used MyFitnessPal. In addition, 32% of intervention group participants and 19% of control group participants were lost to follow-up at 6 months. The app was given to patients by research assistants, not by physicians.ConclusionSmartphone apps for weight loss may be useful for persons who are ready to self-monitor calories, but introducing a smartphone app is unlikely to produce substantial weight change for most patients.Primary funding sourceRobert Wood Johnson Foundation Clinical Scholars Program, National Institutes of Health/National Center for Advancing Translational Sciences for the UCLA Clinical and Translational Science Institute, and the Resource Centers for Minority Aging Research Center for Health Improvement of Minority Elderly under the National Institutes of Health/National Institute on Aging

Effectiveness of a smartphone application for weight loss compared with usual care in overweight primary care patients: a randomized, controlled trial.

BackgroundMany smartphone applications (apps) for weight loss are available, but little is known about their effectiveness.ObjectiveTo evaluate the effect of introducing primary care patients to a free smartphone app for weight loss.DesignRandomized, controlled trial. (ClinicalTrials.gov: NCT01650337).Setting2 academic primary care clinics.Patients212 primary care patients with body mass index of 25 kg/m2 or greater.Intervention6 months of usual care without (n = 107) or with (n = 105) assistance in downloading the MyFitnessPal app (MyFitnessPal).MeasurementsWeight loss at 6 months (primary outcome) and changes in systolic blood pressure and behaviors, frequency of app use, and satisfaction (secondary outcomes).ResultsAfter 6 months, weight change was minimal, with no difference between groups (mean between-group difference, -0.30 kg [95% CI, -1.50 to 0.95 kg]; P = 0.63). Change in systolic blood pressure also did not differ between groups (mean between-group difference, -1.7 mm Hg [CI, -7.1 to 3.8 mm Hg]; P = 0.55). Compared with patients in the control group, those in the intervention group increased use of a personal calorie goal (mean between-group difference, 2.0 d/wk [CI, 1.1 to 2.9 d/wk]; P < 0.001), although other self-reported behaviors did not differ between groups. Most users reported high satisfaction with MyFitnessPal, but logins decreased sharply after the first month.LimitationsDespite being blinded to the name of the app, 14 control group participants (13%) used MyFitnessPal. In addition, 32% of intervention group participants and 19% of control group participants were lost to follow-up at 6 months. The app was given to patients by research assistants, not by physicians.ConclusionSmartphone apps for weight loss may be useful for persons who are ready to self-monitor calories, but introducing a smartphone app is unlikely to produce substantial weight change for most patients.Primary funding sourceRobert Wood Johnson Foundation Clinical Scholars Program, National Institutes of Health/National Center for Advancing Translational Sciences for the UCLA Clinical and Translational Science Institute, and the Resource Centers for Minority Aging Research Center for Health Improvement of Minority Elderly under the National Institutes of Health/National Institute on Aging

Effectiveness of a Smartphone Application for Weight Loss Compared With Usual Care in Overweight Primary Care Patients

BACKGROUND: Tens of thousands of health-related smartphone applications (apps), including hundreds of weight loss apps, are available but little is known about the effectiveness of these programs. OBJECTIVE: To evaluate the impact of introducing patients to a popular, free smartphone app for weight loss, MyFitnessPal, in a primary care setting. DESIGN: Randomized, controlled trial. SETTING: Two primary care clinics in the University of California Los Angeles Health System. PATIENTS: 212 primary care patients with body mass index greater than or equal to 25 kg/m(2). INTERVENTION: 6 months of usual care (n = 107) or usual care plus research assistant help in downloading the MyFitnessPal app onto the patient’s smartphone (n = 105). MEASUREMENTS: Weight loss at six months (primary outcome), change in systolic blood pressure (SBP), change in behavioral mediators, satisfaction with the app, and frequency of app use (secondary outcomes). RESULTS: There was no significant difference between intervention and control groups in weight change (mean between group difference, −0.67 lb [CI, −3.3 to 2.1lb]; p = 0.63) or in SBP (mean between group difference, −1.7 mmHg [CI, −7.1 to 3.8]; p = 0.55). The intervention group exhibited increased use of a personal calorie goal compared to the control group (mean between group difference, 2.0 days per week [CI, 1.1 to 2.9]; p < .001), though changes in other self-reported behaviors did not differ between the groups. Most users reported high satisfaction with MyFitnessPal but logins dropped sharply after the first month. LIMITATION: Despite blinding to the name of the app, fourteen control group participants (16%) used MyFitnessPal. 32% of intervention group participants and 19% of control group participants were lost to follow-up at 6 months. The app was given to patients by research assistants, not by physicians. CONCLUSION: Smartphone apps for weight loss may be useful for individuals who are ready to self-monitor calories. For the average overweight primary care patient, however, introducing a smartphone app is unlikely to produce significant weight change