Context, Culture, and the Complexity of De-Implementing Low-Value Care; Comment on “Key Factors that Promote Low-Value Care: Views of Experts From the United States, Canada, and the Netherlands”

Document Type : Commentary


1 Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada

2 School of Health Administration, Faculty of Health, Dalhousie University, Halifax, NS, Canada

3 Department of Critical Care Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada

4 Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada

5 O’Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada


Low-value care contributes to poor quality of care and wasteful spending in healthcare systems. In Verkerk and colleagues’ recent qualitative study, interviews with low-value care experts from Canada, the United States, and the Netherlands identified a broad range of nationally relevant social, system, and knowledge factors that promote ongoing use of low-value care. These factors highlight the complexity of the problem that is persistent use of low-value care and how it is heavily influenced by public and medical culture as well as healthcare system features. This commentary discusses how these findings integrate within current low-value care and de-implementation literature and uses specific low-value care examples to highlight the importance of considering context, culture, and clinical setting when considering how to apply these factors to future de-implementation initiatives.


  • epublished Author Accepted Version: January 23, 2022
  • epublished Final Version: February 9, 2022
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Volume 11, Issue 8
August 2022
Pages 1592-1594
  • Receive Date: 27 November 2021
  • Revise Date: 19 January 2022
  • Accept Date: 22 January 2022
  • First Publish Date: 23 January 2022