Purpose: Choosing Wisely TM engaged medical specialties, creating "top 5 lists" of low-value services. We describe primary care physicians' (PCPs') self-reported use of these services and perceived barriers to guideline adherence. We quantify physician cost consciousness and determine associations with use. Methods: PCP attendees of a continuing medical education conference completed a survey. For each Family Medicine Choosing Wisely behavior, participants reported clinical adherence. Likert

more »

... le items assessed perceived barriers. Low-value service frequency was the dependent variable. A validated Cost Consciousness Scale created the predictor variable. We hypothesized that participants with greater cost consciousness would report less frequent use of low-value services. Results: Of 199 PCP attendees, 143 (72%) participated. Papanicolaou test after hysterectomy was performed least (0.2 mean services performed/10 patients). Provider knowledge of sinusitis treatment guidelines was greatest but provided most frequently (3.9 mean services performed/10 patients). Practice related barriers were perceived most frequently for adhering to sinusitis treatment guidelines. Attitudinal barriers were greatest for avoiding osteoporosis screening in low risk patients. Greater cost consciousness was associated with less use of low-value services (P ‫؍‬ .03), greater knowledge of guidelines (P ‫؍‬ .001), and fewer perceived attitudinal and practice behavior-related barriers (P < .001 for each). Greater knowledge of guidelines was not associated with less use of low-value services (P ‫؍‬ .58). Familiarity with Choosing Wisely was associated with both greater cost consciousness (P ‫؍‬ .004) and less use of low-value services (P ‫؍‬ .03). Conclusions: Greater PCP cost consciousness was associated with less use of low-value services. Interventions to decrease perceived barriers and increase cost consciousness, perhaps by increasing awareness of Choosing Wisely, may translate into improved performance. (J Am Board Fam Med 2016; 29:785-792.) The current level of health care spending in the United States is not sustainable. Americans spend 20% of the nation's gross national product on health care. 1 More than quarter of that-about $750 billion a year-are for low-value services. The American College of Physicians stated that a medical service provides high value if its health benefits This article was externally peer reviewed.