Physicians’ Group Targets Inappropriate Tests, Treatments

The National Physicians Alliance recommends limiting early imaging use for low back pain because such early use does not improve outcomes but does increase costs. (Image: Levent Konuk/

By eliminating just a handful of commonly ordered diagnostic tests or treatments that either offer limited benefits or may even do more harm than good, health professionals could show a skeptical public that high-quality care and efficient use of resources are complementary, advises a physicians’ group today in an article released online by the Archives of Internal Medicine.

The report was the product of a project of the National Physicians Alliance, a group of 22 000 members that was founded in 2005 with the primary mission of ensuring affordable high-quality health care for all.

The Archives article offers “top 5” lists of tests or treatments that deserve scrutiny based on evidence from the scientific literature in the primary care specialties of family medicine, internal medicine, and pediatrics. The lists were created by surveying alliance members in these specialties and asking them to rate various tests or treatments based on their experience on their frequency of use and their potential to affect the quality and cost of care.

Among the items in the top 5 list for family medicine is limiting early imaging for low back pain, avoiding routinely prescribing antibiotics for sinus infections, and forgoing electrocardiograms or other cardiac screening for low-risk patients without symptoms. For internal medicine, the alliance recommends not ordering blood panels or urinalysis for screening in healthy adults without symptoms, limiting initial statin prescriptions to generic versions, and reserving bone density scans for women aged 65 years or older and for men with risk factors who are aged 70 years or older. For pediatric patients, the group advises physicians to avoid prescribing an antibiotic for a sore throat unless tests for Streptococcus are positive, to limit diagnostic imaging for minor head injuries without loss of consciousness or other risk factors, and to avoid referring patients with middle-ear infections to specialists too early.

The top 5 lists will be distributed to all alliance physicians in their respective primary care specialties. The alliance is also planning to produce videos for patients that explain the rationale for the recommendations by showing that risks outweigh benefits for these interventions for at least some patients, and make clear the link between overuse and health insurance premium hikes.

Categories: Evidence-Based Medicine, Medical Practice, Pediatrics, Primary Care/Family Medicine, Quality of Care