Patient and Physician Attitudes Toward Low-Value Diagnostic Tests and Discussions of Health Care Costs

Abstract

Background: Optimizing patient outcomes while containing costs is a societal priority. To meet this goal patients and physicians need a shared understanding of high value care. Methods: To assess perceptions of the value of care we conducted a cross-sectional survey of primary care patients and physicians at three medical centers. Participants were given two vignettes. One described a patient with a headache requesting a Computed Tomography (CT) scan, and the second described a patient with upper respiratory infection (URI) symptoms requesting antibiotics. Respondents rated the care provided in vignettes and were queried about attitudes toward discussing healthcare costs in clinical encounters. Results: The response rate was 69% (218/318) for patients and 53% (151/283) for physicians. Physicians were more likely than patients to rate not ordering the CT scan (81% vs. 36%, P<0.001) and not prescribing antibiotics (95% vs. 66%, P<0.001) as high value. Patients’ rating of vignettes as high value increased 15% after disclosure of the harms of radiation (36% to 51%, P<0.001) and guidelines discouraging antibiotics for URIs (65% to 79%, P<0.001). Physicians were more likely than patients to be comfortable considering individual patient costs (90% vs. 48%, P<0.001) and national healthcare costs (76% vs. 34%, P<0.001) during clinical encounters. Conclusions: Although there is significant disagreement between physicians’ and patients’ perceptions of high value care, this gap narrows with education. Sharing guidelines and the reasons for not providing low value interventions is critical to achieving greater concordance between patients’ and physicians’ understanding of high value care.