Introduction The need to reduce the use of healthcare practices which provide no value has led to the development of initiatives seeking to improve the appropriateness of clinical and healthcare practice by identifying potentially inappropriate healthcare services, making recommendations, and proposing improvement actions. The online portal DianaHealth (www.dianahealth.com) identifies, gathers, classifies, and publishes clinical recommendations of diverse scientific societies from all over the world for ease of reference.

Objectives To identify the awareness, perceived usefulness and clinical applicability of low-value published recommendations on diagnostic interventions considered by Spanish physicians and healthcare managers.

Methods We designed a survey asking about the recommendations on diagnostic tests published for each medical specialty on DianaHealth to September 2016. It included some common questions about the knowledge and opinion concerning the most established initiatives as well as questions on specific diagnostic recommendations for each medical speciality (531 in total). Along 2017 we conducted this survey among the clinical leaders of 18 Spanish hospitals and primary care centres, using an electronic platform accessed by the people who accepted the invitation to participate.

Results A total of 413 (39%) physicians from 34 different specialties participated, and the answers provided varied between centres (range 21%–100%) and specialties (range 12%–79%). Do Not Do (57%) was the most widely known initiative. Most participants (82%; range 14%–100%) stated that they knew at least one of the 13 initiatives that identify non–recommended practices, with a mean of four initiatives (range 1%–12%). The perceived usefulness was 77% (range 14%–100%), and applicability scored 74% (range 21%–100%). Sixty-one per cent (range 19%–94%) claimed to know the recommendations of their corresponding specialty. A total of 78% (range 36%–98%) agreed with them and 78% (range 37%–100%) considered them useful. We assessed 531 recommendations; 52% (range 12%–82%) were considered totally implemented in clinical practice, and perception —among those who agreed with them— of total and partial compliance was 50% (range 12%–82%) and 41% (range 16%–79%), respectively.

Conclusions 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. Clinical leaders continue to be little aware of the existence of initiatives addressed to improving clinical appropriateness, despite considering them useful. More dissemination actions, addressed to professionals who should know and apply these recommendations, are required.