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Scientific Research

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RPA Janssen MD PhD visits the Symposium Technology meets Value-Based Health Care. This...

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Two new publications

RPA Janssen MD PhD is co-author of 2 new peer reviewed publications this month in Knee...

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Preferences and beliefs of Dutch orthopaedic surgeons and patients reduce the implementation of

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

Rietbergen T, Diercks RL, Anker-van der Wel I, van den Akker-van Marle ME, Lopuhaä N, Janssen RPA, van der Linden-van der Zwaag HMJ, Nelissen RGHH, Marang-van de Mheen PJ, van Bodegom-Vos L
Knee Surg Sports Traumatol Arthrosc. 2019 Sep 25. doi: 10.1007/s00167-019-05708-8. [Epub ahead of print] PMID: 31555844

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.


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RPA Janssen, MD PhD 
Orthopaedic Surgeon
Orthopaedic Associates Eindhoven Greater Area
Orthopedic Center Máxima
Máxima Medical Center (MMC)

Visiting adress MMC Eindhoven:
Ds. Th. Fliednerstraat 1
Ingang Zuid
5631 BM  Eindhoven
The Netherlands 
(outpatient clinic and surgery)

Visiting adress MMC Veldhoven:
De Run 4600
5504 DB  Veldhoven
The Netherlands
(Outpatient clinic)

Mail adress:
Postbus 90052
5600 PD  Eindhoven
The Netherlands

Tel. 0031 (0)40 88 88 600
(Call center Orthopedie)

Fax: 0031 (0)40 88 85 938
www.rpajanssen.com 

Links:
Orthopaedic Associates Eindhoven Greater Area
Máxima Medical Center
Orthopaedic Center Máxima
 

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