Survey among Spanish doctors about worldwide initiatives aiming to reduce low-value health practices and their diagnostic recommendations




Poster session 2


Monday 17 September 2018 - 12:30 to 14:00

All authors in correct order:

Bonfill Cosp X1, Requeijo C1, Salas K1, Quintana MJ1, Merchán AM1, Medarde E2, DianaSalud Survey Group. OBO1
1 Hospital de Sant Pau, Iberoamerican Cochrane Centre, CIBERESP, Universitat Autònoma de Barcelona, Spain
2 Consorci Sanitari de Terrassa, Universitat Autònoma de Barcelona, Spain
Presenting author and contact person

Presenting author:

Xavier Bonfill Cosp

Contact person:

Abstract text
We developed DianaSalud/* (, an independent, free and periodically updated on-line portal that disseminates - in English and Spanish - recommendations to reduce low-value health care interventions published by different initiatives worldwide.

To evaluate the degree of knowledge, perceived usefulness and clinical applicability among Spanish doctors of the recommendations that aim to reduce low-value health diagnostic interventions.

We designed a survey from the diagnostic interventions published in DianaHealth until September 2016. This included some common questions about knowledge and opinions in relation to the best established initiatives, as well as questions about specific diagnostic recommendations for each medical speciality (531 in total). Throughout 2017 we conducted this survey among the clinical leaders of 18 Spanish hospitals and primary-care centres, using an electronic platform.

About 39% (413) of the target population participated, pertaining to 34 specialities. Variability in participation was high among centres (range 21% to 100%) and specialities (12% to 79%). NICE’s DoNotDo was the best known initiative (57%). About 82% of participants (range among specialities: 50% to 100%) were aware of at least one initiative, with a mean of four initiatives (range: 1 to 12); 77% (range: 14% to 100%) considered them as useful and 74% (range: 21% to 100%) as applicable. About 61% (range: 32% to 87%) were aware of the proposed recommendations for their speciality, 78% (range: 40% to 93%) agreed on them, and 78% (range: 46% to 94%) considered them as useful. Among the 531 recommendations, 52% (12% to 83%) were considered to be completely followed in clinical practice, 42% (17% to 74%) only partially, and 6% not at all.

There is a large variability among Spanish doctors, centres and medical specialities, regarding knowledge, perceived usefulness, and clinical applicability of initiatives and recommendations aimed to reduce low-value diagnostic interventions. More effective disseminative actions should be promoted in order for them to become better known and applied.

*Bonfill X, Osorio D, Solà I et al. (2016), an On-Line Database Containing Appraisals of the Clinical Value and Appropriateness of Healthcare Interventions: Database Development and Retrospective Analysis. PLoS ONE 11(2): e0147943

Relevance to patients and consumers: 

Patients should be aware of the diverse initiatives and recommendations aimed to reduce low-value practices when being exposed to them in order to take more informed decisions.