{
  "abstract": "Objective To evaluate the effectiveness of various de-implementation interventions in primary care, targeting care (treatments or tests) that provides no or limited value for patients (low value care).Design Systematic review and meta-analysis.Data sources Medline and Scopus databases, from inception to 10 July 2024.Eligibility criteria for selecting studies Randomised trials comparing de-implementation interventions with placebo or sham intervention, no intervention, or other de-implementation intervention strategies in primary care. Eligible trials provided information on the use of low value care, total volume of care, appropriate care, and health outcomes.Data extraction and synthesis Titles, abstracts, and full texts were screened, data were extracted, and risk of bias was assessed independently and in duplicate. Random effects meta-analyses were conducted, and the certainty of evidence was assessed with the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach.Results 13 008 abstracts were screened and 140 were eligible for inclusion in the study. Median follow-up was 287 days (interquartile range 180-365). In 75 (54%) trials the aim was to reduce the use of antibiotics, in 42 (30%) to reduce other drug treatments, in 17 (12%) to reduce imaging, and in 15 (11%) to reduce laboratory testing. The certainty of the evidence was moderate that provider education combined with audit and feedback reduced the use of targeted low value care (odds ratio 0.73, 95% confidence interval (95% CI) 0.63 to 0.84). Provider education (0.86, 95% CI 0.72 to 1.03), audit and feedback (0.82, 0.67 to 1.00), and patient education (0.70, 0.30 to 1.66), and a combination of these strategies (point estimates for odds ratios ranging from 0.57 to 0.64) may reduce the use of targeted low value care (low certainty of evidence for all).Conclusions The results suggested with moderate certainty of evidence that provider education combined with audit and feedback reduced the use of targeted low value care. Individual strategies may slightly reduce the use of targeted low value care, but achieving a meaningful impact on low value care may require the use of multiple strategies. The results may be useful for patients, clinicians, policy makers, and guideline developers when deciding on future de-implementation strategies and research priorities.Systematic review registration PROSPERO CRD42023411768.",
  "authors": [
    {
      "affiliations": [
        "Finnish Medical Society Duodecim, Helsinki, Finland",
        "Faculty of Medicine, University of Helsinki, Helsinki, Finland"
      ],
      "name": "Aleksi Raudasoja"
    },
    {
      "affiliations": [
        "Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada",
        "Department of Oncology, McMaster University, Hamilton, Ontario, Canada"
      ],
      "name": "Sameer Parpia"
    },
    {
      "affiliations": [
        "Mehiläinen Oy, Helsinki, Finland"
      ],
      "name": "Jussi M J Mustonen"
    },
    {
      "affiliations": [
        "Department of Nephrology and Hypertension, University Medical Centre Utrecht, Utrecht, Netherlands",
        "Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, Netherlands"
      ],
      "name": "Robin Vernooij"
    },
    {
      "affiliations": [
        "Finnish Coordinating Center for Health Technology Assessment, Oulu University Hospital and University of Oulu, Oulu, Finland"
      ],
      "name": "Petra Falkenbach"
    },
    {
      "affiliations": [
        "Department of Urology, Nagoya City University Mirai Kousei Hospital, Nagoya, Japan"
      ],
      "name": "Yoshitaka Aoki"
    },
    {
      "affiliations": [
        "Faculty of Medicine, University of Helsinki, Helsinki, Finland",
        "Department of Medical Informatics, Erasmus Medical Center, Rotterdam, Netherlands"
      ],
      "name": "Anton Barchuk"
    },
    {
      "affiliations": [
        "Department of Primary and Long-Term Care, University Medical Centre Groningen, Groningen, Netherlands"
      ],
      "name": "Marco H Blanker"
    },
    {
      "affiliations": [
        "Institute of Reproductive and Developmental Biology, Imperial College London, London, UK",
        "Department of Urogynaecology, Chelsea and Westminster NHS Foundation Trust, London, UK"
      ],
      "name": "Rufus Cartwright"
    },
    {
      "affiliations": [
        "Department of Emergency Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada"
      ],
      "name": "Kathryn Crowder"
    },
    {
      "affiliations": [
        "Department of Surgery, Universidad del Valle, Cali, Colombia"
      ],
      "name": "Herney Andres Garcia-Perdomo"
    },
    {
      "affiliations": [
        "Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada",
        "Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia"
      ],
      "name": "Rachel Gutschon"
    },
    {
      "affiliations": [
        "Faculty of Medicine, University of Helsinki, Helsinki, Finland"
      ],
      "name": "Alex L E Halme"
    },
    {
      "affiliations": [
        "Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland"
      ],
      "name": "Tuomas P Kilpeläinen"
    },
    {
      "affiliations": [
        "Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland"
      ],
      "name": "Ilari Kuitunen"
    },
    {
      "affiliations": [
        "Finnish Medical Society Duodecim, Helsinki, Finland"
      ],
      "name": "Tiina Lamberg"
    },
    {
      "affiliations": [
        "Department of Emergency Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada"
      ],
      "name": "Eddy Lang"
    },
    {
      "affiliations": [
        "Ministry of Public Health of the Dominican Republic, Santo Domingo, Dominican Republic"
      ],
      "name": "Jenifer Matos"
    },
    {
      "affiliations": [
        "Faculty of Medicine, University of Helsinki, Helsinki, Finland",
        "Hatanpää Health Centre, Wellbeing Services County of Pirkanmaa, Tampere, Finland"
      ],
      "name": "Olli P O Nevalainen"
    },
    {
      "affiliations": [
        "Faculty of Medicine, University of Helsinki, Helsinki, Finland"
      ],
      "name": "Niko K Nordlund"
    },
    {
      "affiliations": [
        "Faculty of Medicine, University of Helsinki, Helsinki, Finland"
      ],
      "name": "Negar Pourjamal"
    },
    {
      "affiliations": [
        "Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark",
        "Institute of Dentistry, University of Eastern Finland, Kuopio, Finland"
      ],
      "name": "Eero Raittio"
    },
    {
      "affiliations": [
        "Division of Urology, Department of Surgery, Sherbrooke University Hospital, Sherbrooke, Quebec, Canada"
      ],
      "name": "Patrick O Richard"
    },
    {
      "affiliations": [
        "Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada",
        "Department of Surgery, McMaster University, Hamilton, Ontario, Canada",
        "Department of Surgery, Woodstock Hospital, Woodstock, Ontario, Canada"
      ],
      "name": "Philippe D Violette"
    },
    {
      "affiliations": [
        "Finnish Medical Society Duodecim, Helsinki, Finland"
      ],
      "name": "Jorma T Komulainen"
    },
    {
      "affiliations": [
        "Finnish Medical Society Duodecim, Helsinki, Finland"
      ],
      "name": "Raija Sipilä"
    },
    {
      "affiliations": [
        "Faculty of Medicine, University of Helsinki, Helsinki, Finland",
        "Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada",
        "Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland",
        "Department of Surgery, Päijät-Häme Central Hospital, Lahti, Finland"
      ],
      "name": "Kari A O Tikkinen"
    }
  ],
  "title": "Effectiveness of different de-implementation strategies in primary care: systematic review and meta-analysis",
  "uid": "138416ff-d306-54ed-8dd8-031de72dd3c3"
}