{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T00:58:03Z","timestamp":1791334683735,"version":"4.3.1"},"reference-count":41,"publisher":"BMJ","issue":"11","license":[{"start":{"date-parts":[[2024,11,23]],"date-time":"2024-11-23T00:00:00Z","timestamp":1732320000000},"content-version":"unspecified","delay-in-days":22,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004587","name":"Carlos III Health Institute","doi-asserted-by":"crossref","award":["INT22\/00012"],"award-info":[{"award-number":["INT22\/00012"]}],"id":[{"id":"10.13039\/501100004587","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100003359","name":"Generalitat Valenciana","doi-asserted-by":"publisher","award":["Prometeu 2021\/061"],"award-info":[{"award-number":["Prometeu 2021\/061"]}],"id":[{"id":"10.13039\/501100003359","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100020619","name":"Miguel Hern\u00e1ndez University of Elche","doi-asserted-by":"crossref","award":["2022\/PER\/00002"],"award-info":[{"award-number":["2022\/PER\/00002"]}],"id":[{"id":"10.13039\/100020619","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2024,11,2]]},"published-print":{"date-parts":[[2024,11]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Overuse of medical services is a challenge worldwide, posing a threat to the quality of care, patient safety and the sustainability of healthcare systems. Some data suggest that females receive more low-value practices (LVPs)\u2014defined as medical interventions that provide little or no benefit to patients and can even cause harm\u2014than males. This study aims to evaluate and compare the occurrence of LVPs in primary care among both males and females.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>A retrospective study was conducted.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Primary care in the Alicante province (Spain) during 2022.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Data were extracted from the digital medical records of 978\u2009936 patients attended by 1125 family physicians across 262 primary healthcare centres in the Alicante province.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcome measures<\/jats:title>\n                    <jats:p>Data on age, sex, diagnosis and treatment were extracted. The primary outcome measure was the frequency of 12 selected LVPs prescribed to male and female patients. These LVPs were expected to be relatively frequent occurrences with the potential to cause harm.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 45\u2009955 LVPs were identified, of which 28\u2009148 (5.27% of 534 603, CI95% 5.20\u20135.32) were prescribed to female patients and 17\u2009807 (4.00% of 444 333, CI95% 3.95\u20134.06) to male patients (x\u00b2, p value &lt;0.0001). The most common LVPs were prescribing treatment for overactive bladder without excluding other pathologies that may cause similar symptoms (30.87%), using hypnotics without having a previous aetiological diagnosis in patients with difficulty maintaining sleep (14%) and recommending analgesics (NSAIDs, paracetamol and others) for more than 15 days per month in primary headaches that do not respond to treatment (13.33%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Future clinical training, management and research must consider biological differences or those based on gender factors when analysing the frequency and causes of LVP.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT05233852\">NCT05233852<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2024-089006","type":"journal-article","created":{"date-parts":[[2024,11,24]],"date-time":"2024-11-24T14:36:05Z","timestamp":1732458965000},"page":"e089006","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"title":["Low-value practices in primary care: a cross-sectional study comparing data between males and females in Spain"],"prefix":"10.1136","volume":"14","clinical-trial-number":[{"clinical-trial-number":"nct05233852","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct05233852","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct05233852","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6497-083X","authenticated-orcid":false,"given":"Jos\u00e9 Joaqu\u00edn","family":"Mira","sequence":"first","affiliation":[{"name":"ATENEA Research Foundation for the Promotion of Health and Biomedical Research of Valencia Region, FISABIO, Alicante, Spain"},{"name":"Health Psychology Department, Miguel Hernandez University of Elche, Elche, Spain"},{"name":"RICAPPS - Red de Investigaci\u00f3n en Cronicidad, Atenci\u00f3n Primaria y Prevenci\u00f3n y Promoci\u00f3n de la Salud, Elche, Spain"},{"name":"RICAPPS - Red de Investigaci\u00f3n en Cronicidad, Atenci\u00f3n Primaria y Prevenci\u00f3n y Promoci\u00f3n de la Salud, San Juan de Alicante, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Concepci\u00f3n","family":"Carratal\u00e1-Munuera","sequence":"additional","affiliation":[{"name":"RICAPPS - Red de Investigaci\u00f3n en Cronicidad, Atenci\u00f3n Primaria y Prevenci\u00f3n y Promoci\u00f3n de la Salud, San Juan de Alicante, Spain"},{"name":"Clinical Medicine Department, Miguel Hernandez University of Elche, Sant Joan d'Alacant, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Garc\u00eda-Torres","sequence":"additional","affiliation":[{"name":"ATENEA Research Foundation for the Promotion of Health and Biomedical Research of Valencia Region, FISABIO, Alicante, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristina","family":"Soriano","sequence":"additional","affiliation":[{"name":"Centro de Salud de Mutxamel, Mutxamel, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-7943-3030","authenticated-orcid":false,"given":"Alicia","family":"S\u00e1nchez-Garc\u00eda","sequence":"additional","affiliation":[{"name":"Health Psychology Department, Miguel Hernandez University of Elche, Elche, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vicente F","family":"Gil-Guillen","sequence":"additional","affiliation":[{"name":"RICAPPS - Red de Investigaci\u00f3n en Cronicidad, Atenci\u00f3n Primaria y Prevenci\u00f3n y Promoci\u00f3n de la Salud, San Juan de Alicante, Spain"},{"name":"Clinical Medicine Department, Miguel Hernandez University of Elche, Sant Joan d'Alacant, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8630-7251","authenticated-orcid":false,"given":"Mar\u00eda Asunci\u00f3n","family":"Vicente","sequence":"additional","affiliation":[{"name":"Health Psychology Department, Miguel Hernandez University of Elche, Elche, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9089-0497","authenticated-orcid":false,"given":"M\u00aa Virtudes","family":"P\u00e9rez-Jover","sequence":"additional","affiliation":[{"name":"Health Psychology Department, Miguel Hernandez University of Elche, Elche, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adriana","family":"Lopez-Pineda","sequence":"additional","affiliation":[{"name":"RICAPPS - Red de Investigaci\u00f3n en Cronicidad, Atenci\u00f3n Primaria y Prevenci\u00f3n y Promoci\u00f3n de la Salud, San Juan de Alicante, Spain"},{"name":"Clinical Medicine Department, Miguel Hernandez University of Elche, Sant Joan d'Alacant, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2024,11,24]]},"reference":[{"key":"2025121222172731000_14.11.e089006.1","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1001\/jamainternmed.2021.6911","article-title":"Longitudinal Content Analysis of the Characteristics and Expected Impact of Low-Value Services Identified in US Choosing Wisely Recommendations","volume":"182","author":"Ganguli","year":"2022","journal-title":"JAMA Intern Med"},{"key":"2025121222172731000_14.11.e089006.2","first-page":"336","article-title":"Choosing Wisely in primary care: Moving from recommendations to implementation","volume":"64","author":"Wintemute","year":"2018","journal-title":"Can Fam Physician"},{"key":"2025121222172731000_14.11.e089006.3","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1007\/s10354-015-0426-x","article-title":"Choosing wisely in case of hypertension, diabetes and hyperlipidemia in older patients","volume":"166","author":"Dovjak","year":"2016","journal-title":"Wien Med Wochenschr"},{"key":"2025121222172731000_14.11.e089006.4","doi-asserted-by":"publisher","DOI":"10.3122\/jabfm.2015.05.140332"},{"key":"2025121222172731000_14.11.e089006.5","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2020.37328","article-title":"Trends in Low-Value Health Service Use and Spending in the US Medicare Fee-for-Service Program, 2014-2018","volume":"4","author":"Mafi","year":"2021","journal-title":"JAMA Netw Open"},{"key":"2025121222172731000_14.11.e089006.6","doi-asserted-by":"crossref","first-page":"1913","DOI":"10.1001\/jamainternmed.2015.5441","article-title":"Early Trends Among Seven Recommendations From the Choosing Wisely Campaign","volume":"175","author":"Rosenberg","year":"2015","journal-title":"JAMA Intern Med"},{"key":"2025121222172731000_14.11.e089006.7","doi-asserted-by":"crossref","first-page":"568","DOI":"10.1111\/1475-6773.13917","article-title":"Choosing Wisely: An idea worth sustaining","volume":"57","author":"Kastner","year":"2022","journal-title":"Health Serv Res"},{"key":"2025121222172731000_14.11.e089006.8","doi-asserted-by":"crossref","first-page":"567","DOI":"10.1007\/s15010-023-02005-y","article-title":"Choosing Wisely internationally - helpful recommendations for antimicrobial stewardship!","volume":"51","author":"Jung","year":"2023","journal-title":"Infection"},{"key":"2025121222172731000_14.11.e089006.9","doi-asserted-by":"publisher","DOI":"10.9778\/cmajo.20180053"},{"key":"2025121222172731000_14.11.e089006.10","doi-asserted-by":"crossref","first-page":"995","DOI":"10.1080\/14740338.2022.2026924","article-title":"Frequency and estimated costs of ten low-value practices in the Spanish primary care: a retrospective study","volume":"21","author":"Cheikh-Moussa","year":"2022","journal-title":"Expert Opin Drug Saf"},{"key":"2025121222172731000_14.11.e089006.11","unstructured":"Spanish Health Ministry . Quality commitment campaign. 2013. Available: https:\/\/seguridaddelpaciente.sanidad.gob.es\/proyectos\/financiacionEstudios\/colaboracionSSCC\/compromisoCalidad.htm"},{"key":"2025121222172731000_14.11.e089006.12","unstructured":"Spanish Society of Family and Community Medicine . Community orientation: do\u2019s and don\u2019ts in primary care, sem fyc document no.38. 2018. Available: https:\/\/www.semfyc.es\/formacion-y-recursos\/orientacion-comunitaria-hacer-y-no-hacer-en-atencion-primaria-documento-semfyc-no-38\/"},{"key":"2025121222172731000_14.11.e089006.13","doi-asserted-by":"crossref","first-page":"2094","DOI":"10.1111\/jgs.16038","article-title":"Management of Sleep Disorders in Community-Dwelling Older Women and Men at the Time of Diagnosis","volume":"67","author":"Pop","year":"2019","journal-title":"J Am Geriatr Soc"},{"key":"2025121222172731000_14.11.e089006.14","doi-asserted-by":"crossref","first-page":"1568","DOI":"10.1001\/jamainternmed.2019.3842","article-title":"2019 Update on Medical Overuse: A Review","volume":"179","author":"Morgan","year":"2019","journal-title":"JAMA Intern Med"},{"key":"2025121222172731000_14.11.e089006.15","doi-asserted-by":"crossref","first-page":"2087","DOI":"10.1007\/s10067-021-05638-2","article-title":"Medical overuse of therapies and diagnostics in rheumatology","volume":"40","author":"Khawaja","year":"2021","journal-title":"Clin Rheumatol"},{"key":"2025121222172731000_14.11.e089006.16","doi-asserted-by":"crossref","first-page":"e858","DOI":"10.1097\/PTS.0000000000000830","article-title":"Avoidable Adverse Events Related to Ignoring the Do-Not-Do Recommendations: A Retrospective Cohort Study Conducted in the Spanish Primary Care Setting","volume":"17","author":"Mira","year":"2021","journal-title":"J Patient Saf"},{"key":"2025121222172731000_14.11.e089006.17","doi-asserted-by":"crossref","first-page":"e290","DOI":"10.1016\/S2666-7568(21)00054-4","article-title":"Polypharmacy, inappropriate prescribing, and deprescribing in older people: through a sex and gender lens","volume":"2","author":"Rochon","year":"2021","journal-title":"Lancet Healthy Longev"},{"key":"2025121222172731000_14.11.e089006.18","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.39335.541782.AD"},{"key":"2025121222172731000_14.11.e089006.19","doi-asserted-by":"crossref","DOI":"10.1186\/s12875-024-02456-8","article-title":"Identification of low-value practices susceptible to gender bias in primary care setting","volume":"25","author":"P\u00e9rez-Jover","year":"2024","journal-title":"BMC Prim Care"},{"key":"2025121222172731000_14.11.e089006.20","doi-asserted-by":"crossref","DOI":"10.1186\/s13037-022-00319-8","article-title":"Patient safety assurance in the age of defensive medicine: a review","volume":"16","author":"Shenoy","year":"2022","journal-title":"Patient Saf Surg"},{"key":"2025121222172731000_14.11.e089006.21","doi-asserted-by":"crossref","DOI":"10.1186\/s12875-024-02267-x","article-title":"The influence of fears of perceived legal consequences on general practitioners\u2019 practice in relation to defensive medicine - a cross-sectional survey in Germany","volume":"25","author":"Goetz","year":"2024","journal-title":"BMC Prim Care"},{"key":"2025121222172731000_14.11.e089006.22","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpain.2008.12.001"},{"key":"2025121222172731000_14.11.e089006.23","doi-asserted-by":"publisher","DOI":"10.1038\/nrn3360"},{"key":"2025121222172731000_14.11.e089006.24","doi-asserted-by":"crossref","DOI":"10.1155\/2018\/6358624","article-title":"'Brave Men' and 'Emotional Women': A Theory-Guided Literature Review on Gender Bias in Health Care and Gendered Norms towards Patients with Chronic Pain","volume":"2018","author":"Samulowitz","year":"2018","journal-title":"Pain Res Manag"},{"key":"2025121222172731000_14.11.e089006.25","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2012.131"},{"key":"2025121222172731000_14.11.e089006.26","doi-asserted-by":"crossref","first-page":"1375","DOI":"10.1111\/apt.17534","article-title":"Review article: Functional dyspepsia and pregnancy-Effects and management in a special population","volume":"57","author":"Liu","year":"2023","journal-title":"Aliment Pharmacol Ther"},{"key":"2025121222172731000_14.11.e089006.27","doi-asserted-by":"crossref","first-page":"316","DOI":"10.1016\/j.semerg.2017.08.007","article-title":"An\u00e1lisis de la utilizaci\u00f3n de inhibidores de la bomba de protones en Atenci\u00f3n Primaria","volume":"44","author":"Hern\u00e1ndez-Arroyo","year":"2018","journal-title":"Med Fam SEMERGEN"},{"key":"2025121222172731000_14.11.e089006.28","doi-asserted-by":"crossref","DOI":"10.1186\/s12875-020-01166-1","article-title":"Evidence for deprescription in primary care through an umbrella review","volume":"21","author":"Olry de Labry Lima","year":"2020","journal-title":"BMC Fam Pract"},{"key":"2025121222172731000_14.11.e089006.29","doi-asserted-by":"crossref","first-page":"2600","DOI":"10.1111\/jgs.16117","article-title":"Low-Value Proton Pump Inhibitor Prescriptions Among Older Adults at a Large Academic Health System","volume":"67","author":"Mafi","year":"2019","journal-title":"J Am Geriatr Soc"},{"key":"2025121222172731000_14.11.e089006.30","article-title":"Deprescribing versus continuation of chronic proton pump inhibitor use in adults","volume":"3","author":"Boghossian","year":"2017","journal-title":"Cochrane Database Syst Rev"},{"key":"2025121222172731000_14.11.e089006.31","doi-asserted-by":"crossref","DOI":"10.1136\/bmjoq-2020-001065","article-title":"Catalan experience of deadoption of low-value practices in primary care","volume":"11","author":"Almaz\u00e1n","year":"2022","journal-title":"BMJ Open Qual"},{"key":"2025121222172731000_14.11.e089006.32","doi-asserted-by":"crossref","DOI":"10.1186\/s12916-020-01567-0","article-title":"Engaging patients in de-implementation interventions to reduce low-value clinical care: a systematic review and meta-analysis","volume":"18","author":"Sypes","year":"2020","journal-title":"BMC Med"},{"key":"2025121222172731000_14.11.e089006.33","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2023-075325","article-title":"Older adults\u2019 attitudes towards deprescribing and medication changes: a longitudinal sub-study of a cluster randomised controlled trial","volume":"14","author":"Jungo","year":"2024","journal-title":"BMJ Open"},{"key":"2025121222172731000_14.11.e089006.34","doi-asserted-by":"crossref","first-page":"212","DOI":"10.1016\/j.rce.2017.02.008","article-title":"Commitment to quality of the Spanish scientific societies","volume":"217","author":"Garc\u00eda-Alegr\u00eda","year":"2017","journal-title":"Rev Clin Esp (Barc)"},{"key":"2025121222172731000_14.11.e089006.35","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2017-021339","article-title":"Drivers and strategies for avoiding overuse. A cross-sectional study to explore the experience of Spanish primary care providers handling uncertainty and patients\u2019 requests","volume":"8","author":"Mira","year":"2018","journal-title":"BMJ Open"},{"key":"2025121222172731000_14.11.e089006.36","doi-asserted-by":"crossref","first-page":"3965","DOI":"10.1007\/s00431-022-04613-6","article-title":"Adherence of Spanish pediatricians to 'do not do' guidelines to avoid low-value care in pediatrics","volume":"181","author":"Pi\u00f1eiro-P\u00e9rez","year":"2022","journal-title":"Eur J Pediatr"},{"key":"2025121222172731000_14.11.e089006.37","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)32585-5"},{"key":"2025121222172731000_14.11.e089006.38","doi-asserted-by":"publisher","DOI":"10.1001\/jama.280.11.1000"},{"key":"2025121222172731000_14.11.e089006.39","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2017.0896"},{"key":"2025121222172731000_14.11.e089006.40","doi-asserted-by":"crossref","first-page":"1401","DOI":"10.1001\/jamainternmed.2018.3573","article-title":"Development of a Conceptual Map of Negative Consequences for Patients of Overuse of Medical Tests and Treatments","volume":"178","author":"Korenstein","year":"2018","journal-title":"JAMA Intern Med"},{"key":"2025121222172731000_14.11.e089006.41","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2019.13978"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2024-089006","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,13]],"date-time":"2025-12-13T06:17:36Z","timestamp":1765606656000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2024-089006"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,11]]},"references-count":41,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2024,11,24]]},"published-print":{"date-parts":[[2024,11]]}},"alternative-id":["10.1136\/bmjopen-2024-089006"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2024-089006","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,11]]}}}