Understanding the Challenge of Low-Value Care

Low-value care (LVC) refers to medical services that provide little to no benefit to patients. Often, these practices may even cause harm or lead to unnecessary healthcare spending. For primary care physicians, deimplementing low-value care is essential for improving patient safety and optimizing resources. While many implementation strategies exist, clinicians often struggle to identify the most effective ways to remove outdated or unnecessary practices from their daily routines.

A recent qualitative study involving 441 primary care physicians in Sweden shed light on this issue. The researchers explored strategies tailored specifically to the primary care context. They found that clinicians believe de-implementation requires more than just individual effort. Instead, it necessitates a multi-layered approach involving leadership, organizational changes, and overarching system reforms.

Key Strategies for Deimplementing Low-Value Care

The study utilized the Expert Recommendations for Implementing Change (ERIC) framework to categorize physician suggestions. Interestingly, the physicians identified 39 distinct strategies across nine original domains. Furthermore, they proposed a new domain: the development of better evidence. This highlights a critical need for clinical guidelines that specifically tell doctors what not to do, rather than just what to do.

Most suggested strategies focus on the organizational and system levels. For instance, clinicians emphasized the importance of changing clinical software to remove prompts for low-value tests. Additionally, they suggested that national health policies must align with de-implementation goals. When the system incentivizes volume over value, deimplementing low-value care becomes significantly more difficult for the individual practitioner.

System-Level Responsibilities in Healthcare

The findings indicate that responsibility for reducing LVC is shared. While individual physicians play a role, the study mapped the majority of strategies to higher system levels. Leadership at the clinic level must foster a culture where de-implementation is encouraged. Moreover, group-level interventions, such as peer-to-peer feedback and clinical audits, can effectively change prescribing habits. Consequently, addressing LVC is not a solitary task but a collective responsibility across the healthcare hierarchy.

Frequently Asked Questions

What is the most effective way to start deimplementing low-value care?

Physicians suggest that starting with clear, evidence-based guidelines that identify specific low-value practices is the first step. Organizational support, such as decision-support tools in electronic health records, further facilitates this process.

Why is individual effort alone insufficient for de-implementation?

Individual effort often clashes with systemic pressures, such as patient expectations or financial incentives. Therefore, broader structural and cultural changes are necessary to ensure that physicians feel supported when choosing to omit a low-value service.

Disclaimer: This content is for informational and educational purposes only and does not constitute medical advice or a professional relationship. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Refer to the latest local and national guidelines for clinical practice.

References

Öfverström HA et al. Physician-suggested strategies for deimplementing low-value care in Swedish primary care: a qualitative analysis across system levels. Implement Sci Commun. 2026 Apr 18. doi: 10.1186/s43058-026-00947-6. PMID: 42001179.

Colla CH, Mainor AJ. De-implementation of low-value care. JAMA. 2020;324(11):1033-1034.

Saini V, Garcia-Armesto S, Klemperer D, et al. Drivers of poor medical care. The Lancet. 2017;390(10090):178-190.