Does the lack of continuity of care in general practice impact service utilization patient outcomes?

BackgroundLow-value care is commonly provided in primary care, resulting in avoidable costs for the health care system and potential harm for patients.It remains unclear how to best encourage physicians to reduce low-value services. ObjectivesTo test whether personalized information combining peer comparison feedback and professional norms can reduce the provision of low-value services in primary care. MethodsDesign: 12-month, nationwide, pragmatic, parallel-group randomized controlled trial.Setting: Primary care physicians (PCPs) in solo practices from 1 November 2020 to 1 November 2021.Participants: 1,816 PCPs with low and high baseline performance in low-value care provision. InterventionPersonalized information letters containing peer comparison feedback and professional norms about vitamin D testing (n = 618) or generic prescribing (n = 597).No letter was sent to physicians in the control group (n = 601).Measurements: Number of vitamin D tests in 100 patients, and the share of generic drugs per physician. ResultsAfter the 12-month intervention, there was an 18.2% reduction in average vitamin D testing, representing a mean reduction of -3.66 tests in 100 patients ([95% CI: -5.42 to -1.89]).The lowest 90% of low-value care providers contributed over 80% of this reduction.Average generic prescribing was not significantly increased through the intervention (mean difference: +0.57pp [95% CI: -0.68 to +1.81 pp]).PCPs with high baseline performance did not increase low-value services. ConclusionPersonalized information interventions can be a cost-effective tool for reducing low-value services in primary care.To enhance their effectiveness, health policymakers should target all providers instead of only those with low baseline performance.