Targeted Interventions Effectively Address Medical Overuse

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Several themes emerged from the review, including an overreliance on high-technology imaging modalities.
Several themes emerged from the review, including an overreliance on high-technology imaging modalities.

Involving patients in shared decision-making and providing clinicians with feedback about their performance relative to their peers may reduce medical overuse, according to a systematic review published in JAMA Internal Medicine.

Daniel J. Morgan, MD, MS, department of epidemiology and public health, University of Maryland School of Medicine in Baltimore and colleagues identified 1224 articles that addressed medical overuse, defined as medical care in which potential harms outweigh benefits. Of those, 122 were found to be the most relevant and the 10 most influential articles were chosen by author consensus.

Several themes emerged from the review, including an overreliance on high-technology imaging modalities. This overreliance results in high rates of unnecessary testing and leads to overdiagnosis, with the accompanying risk of adverse events. 

The authors noted the need for changes in practice or policy to better protect patients from technologies that have a higher risk of causing clinical harm.  They further suggest that the US Food and Drug Administration should require that new technologies and diagnostic tests demonstrate benefits in patient outcomes and not surrogate measures before approval.

Other areas of medical overuse included specific types of care, such as supplemental home oxygen in patients with chronic obstructive pulmonary disease and moderate desaturation, meniscal knee surgery, and nutritional support for medical inpatients. 

One study found that an email intervention that compared clinicians with top peer performers reduced overuse of antibiotics among clinicians prescribing for acute respiratory tract infections: mean inappropriate antibiotic prescription rates dropped from 19.9% before the intervention to 3.7% after intervention.

Another overuse reduction method noted in the review was the use of a decision aid to engage patients with low-risk chest pain in shared decision-making. This increased patient knowledge about their risk for acute coronary syndrome, and these patients were significantly less likely to be admitted for cardiac testing (37% vs 52%) compared with patients receiving usual care.

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Reference

Morgan DJ, Dhruva SS, Coon ER, Wright SM, Korenstein D. 2017 update in medical overuse: A systematic review [published online October 2, 2017]. JAMA Intern Med. doi:10.1001/jamainternmed.2017.4361

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