- •Less is More aims to tackle overuse in medicine.
- •Several anti-waste campaigns published “top-five lists” of low-value medical interventions.
- •Barriers for implementing Less is More medicine have been identified in several European countries.
- •Simple awareness of these recommendations is insufficient to change physician behaviors.
- •Multiple interventions and quality-measurement efforts are necessary for widely implementing these recommendations.
2. Barriers to reducing overuse
2.1 Patients’ expectations
2.2 Physicians’ behaviour
2.3 Patient and physician interaction
2.4 Lack of evidence and universal definition
2.5 Lack of health services research and policy
2.6 Fragmentation of care
3.1 Monitoring and data reporting using variability
3.2 Financial incentives
4. Conclusion and future agenda
Declaration of Competing Interest
- High prevalence of forgoing healthcare for economic reasons in Switzerland: a population-based study in a region with universal health insurance coverage.Prev Med. 2012; 55: 521-527
Maisonneuve C., Martins J.Public spending on health and long term care: a new set of projections. OECD economic policy paper no. 6. Paris: OECD.2013.
- Too much medicine?.BMJ. 2002; 324: 859-860
- Why too much medicine is making us sicker and poorer.Bloomsbury, 2007
- Winding back the harms of too much medicine.BMJ. 2013; 346: f1271
- Less is More: how less health care can result in better health.Arch Intern Med. 2010; 170: 749-750
- Choosing wisely campaigns: a work in progress.JAMA. 2018; 319: 1975-1976
- Italy's "Doing more does not mean doing better" campaign.BMJ. 2014; 349: g4703
- How should top-five lists be developed?: what is the next step?.JAMA Intern Med. 2014; 174: 498-499
- The french society of internal medicine's top-5 list of recommendations: a national web-based survey.J Gen Intern Med. 2019; 34: 1475-1485
- The Romanian society of internal medicine's choosing wisely campaign.Rom J Intern Med. 2019; 57: 181-194
- Choosing wisely Portugal – wise Health decisions.Acta Med Port. 2018; 31: 521-523
- The Italian society of internal medicine choosing wisely campaign.Intern Emerg Med. 2016; 11: 1125-1130
- The challenge of do not do.Rev Clin Esp. 2017; 217: 208-209
- The "top 5" lists in primary care: meeting the responsibility of professionalism.Arch Intern Med. 2011; 171: 1385-1390
- CJEM debate series: #ChoosingWisely – the choosing wisely campaign will not impact physician behaviour and choices.CJEM. 2018; 20: 170-175
- Clinicians' perceptions of barriers to avoiding inappropriate imaging for low back pain-knowing is not enough.JAMA Intern Med. 2016; 176: 1866-1868
- Perceived barriers to implementing individual choosing wisely(r) recommendations in two national surveys of primary care providers.J Gen Intern Med. 2017; 32: 210-217
- La surconsommation de prestations médicales: un problème de qualité.Bull Méd Suisses. 2016; 97: 236-243
- 'Choosing wisely': a growing international campaign.BMJ Qual Saf. 2015; 24: 167-174
- Less medicine more health:7 assumptions that drive too much medical care.Beacon press, 2015
- Progetto bambini a antibiotici " regional g. Why do paediatricians prescribe antibiotics? Results of an Italian regional project.BMC Pediatr. 2009; 9: 69
- Addressing overdiagnosis and overtreatment in cancer: a prescription for change.Lancet Oncol. 2014; 15: e234-e242
- Not so silver lining.Arch Intern Med. 2011; 171: 489-490
- The twin traps of overtreatment and therapeutic nihilism in clinical practice.Med Educ. 2014; 48: 34-43
- ["Less is more"].Rev Med Suisse. 2013; 9 (770): 772-774
- "The ultimate decision is yours": exploring patients' attitudes about the overuse of medical interventions.PLoS ONE. 2012; 7: e52552
- The influence of patients' hopes of receiving a prescription on doctors' perceptions and the decision to prescribe: a questionnaire survey.BMJ. 1997; 315: 1506-1510
- Trends in the overuse of ambulatory health care services in the United States.JAMA Intern Med. 2013; 173: 142-148
- Trends in negative defensive medicine within general practice.Br J Gen Pract: J R Coll Gen Pract. 2000; 50: 565-566
- Defensive medicine practices among gastroenterologists in Lombardy: between lawsuits and the economic crisis.Digest Liver Dis: Off J Ital Soc Gastroenterol Ital Assoc Study Liver. 2013; 45: 469-473
- Legal concerns trigger prostate-specific antigen testing.J Eval Clin Pract. 2009; 15: 390-392
- Physician spending and subsequent risk of malpractice claims: observational study.BMJ. 2015; 351: h5516
- The practice of defensive medicine among hospital doctors in the United Kingdom.BMC Med Ethics. 2013; 14: 42
- Overuse of testing in preoperative evaluation and syncope: a survey of hospitalists.Ann Intern Med. 2015; 162: 100-108
Shrank W.H., Rogstad T.L., Parekh N. Waste in the US health care system: estimated costs and potential for savings. JAMA. 2019.
- Deconstructing the evidence-based discourse in health sciences: truth, power and fascism.Int J Evid Based Healthc. 2006; 4: 180-186
- Medical taylorism.N Engl J Med. 2016; 374: 106-108
- Narrative based medicine: why study narrative?.BMJ. 1999; 318: 48-50
- How evidence-based are the recommendations in evidence-based guidelines?.PLoS Med. 2007; 4: e250
- Wrong guidelines: why and how often they occur.Evid Based Med. 2017; 22: 1-3
- Failure of clinical practice guidelines to meet institute of medicine standards: two more decades of little, if any, progress.Arch Intern Med. 2012; 172: 1628-1633
- Guidelines on the management of atrial fibrillation in the emergency department: a critical appraisal.Intern Emerg Med. 2017; 12: 693-703
- Less is more: overdiagnosis and overtreatment: evaluation of what physicians tell their patients about screening harms.JAMA Intern Med. 2013; 173: 2086-2087
- Addressing overuse of medical services one decision at a time.JAMA Intern Med. 2015; 175: 1092-1093
- The science of choosing wisely–overcoming the therapeutic illusion.N Engl J Med. 2016; 374: 1203-1205
- Physician-patient communication. The relationship with malpractice claims among primary care physicians and surgeons.JAMA. 1997; 277: 553-559
- People's willingness to accept overdetection in cancer screening: population survey.BMJ. 2015; 350: h980
- Cervical cancer screening among women without a cervix.JAMA. 2004; 291: 2990-2993
- Appropriate use of screening and diagnostic tests to foster high-value, cost-conscious care.Ann Intern Med. 2012; 156: 147-149
- Smarter medicine: do physicians need political pressure to eliminate useless interventions?.Swiss Medical Weekly. 2015; 145: w14125
Grilli R. Health services research to orient policy making. “Less is more”proceedings of the Fourth Symposium on Health Services Research; 2015; Bern.
- Overuse of health care services in the United States: an understudied problem.Arch Intern Med. 2012; 172: 171-178
Selby K., Cornuz J., Gaspoz J.M., Senn N. Acceptability and self-reported adherence to the smarter medicine top 5 list among family physicians in Switzerland. In. Annual congress, société suisse de médecine interne générale, Basel2016.
Cerboni S., Domenighetti G.Variabilité chirurgicale en suisse.différences intercantonales observées pour trois interventions. wwwobsanadminch/sites/default/files/publications/2015/arbeitsdokument-23pdf. 2008.
- Using the plan, do, study, act model to implement a quality improvement program in your practice.Am J Gastroenterol. 2016; 111: 1220-1222
- Prevalence of inappropriate antibiotic prescriptions among us ambulatory care visits, 2010-2011.JAMA. 2016; 315: 1864-1873
- Effect of behavioral interventions on inappropriate antibiotic prescribing among primary care practices: a randomized clinical trial.JAMA. 2016; 315: 562-570
- Why don't physicians follow clinical practice guidelines? A framework for improvement.JAMA. 1999; 282: 1458-1465
- Long-term evidence for the effect of pay-for-performance in primary care on mortality in the UK: a population study.Lancet. 2016; 388: 268-274
- Does pay-for-performance in primary care save lives?.Lancet. 2016; 388: 217-218
- Training physicians to provide high-value, cost-conscious care: a systematic review.JAMA. 2015; 314: 2384-2400
- Spending patterns in region of residency training and subsequent expenditures for care provided by practicing physicians for medicare beneficiaries.JAMA. 2014; 312: 2385-2393
The challenge of implementing less is more medicine in Switzerland; 2017. [Accessed 12 April 2020].