2018 update on medical overuse Journal Article


Authors: Morgan, D. J.; Dhruva, S. S.; Coon, E. R.; Wright, S. M.; Korenstein, D.
Article Title: 2018 update on medical overuse
Abstract: Importance: Overuse of medical care is a well-recognized problem in health care, associated with patient harm and costs. We sought to identify and highlight original research articles published in 2017 that are most relevant to understanding medical overuse. Observations: A structured review of English-language articles published in 2017 was performed, coupled with examination of tables of contents of high-impact journals to identify articles related to medical overuse in adult care. Manuscripts were appraised for their quality, clinical relevance, and impact. A total of 1446 articles were identified, 910 of which addressed medical overuse. Of these, 111 articles were deemed to be the most relevant based on originality, methodologic quality, and scope. The 10 most influential articles were selected by author consensus. Findings included that unnecessary electrocardiograms are common (performed in 22% of patients at low risk) and can lead to a cascade of services, lipid monitoring rarely affects care, patients who were overdiagnosed with cancer experienced anxiety and criticism about not seeking treatment, calcium and vitamin D supplementation does not reduce hip fracture (relative risk, 1.09; 95% CI, 0.85-1.39), and pregabalin does not improve symptoms of sciatica but frequently has adverse effects (40% of patients experienced dizziness). Antipsychotic medications increased the severity of delirium in patients receiving hospice care and were associated with an increased risk of death (hazard ratio, 1.7; P =.003), and robotic-assisted radical nephrectomy was without benefits by being slower and more costly than laparoscopic surgery. High-sensitivity troponin testing often yielded false-positive results, as 16% of patients with positive troponin results in a US hospital had a myocardial infarction. One-third of patients who received a diagnosis of asthma had no evidence of asthma. Restructuring the electronic health record was able to reduce unnecessary testing (from 31.3 to 13.9 low-value tests performed per 100 patient visits). Conclusions and Relevance: Many current practices were found to represent overuse, with no benefit and potential harms. Other services were used inappropriately. Reviewing these findings and extrapolating to their patients will enable health care professionals to improve the care they provide.. © 2018 American Medical Association. All rights reserved.
Keywords: review; cancer patient; cancer diagnosis; laparoscopic surgery; delirium; palliative therapy; calcium; dizziness; health service; disease severity; radical nephrectomy; heart infarction; vitamin d; neuroleptic agent; vitamin supplementation; asthma; risk reduction; false positive result; hydroxymethylglutaryl coenzyme a reductase inhibitor; electrocardiogram; hospice care; lipid analysis; unnecessary procedure; hip fracture; pregabalin; adverse event; clinical outcome; troponin; low risk patient; human; priority journal; electronic health record; robot assisted surgery; cancer overdiagnosis; community dwelling person; sciatica
Journal Title: JAMA Internal Medicine
Volume: 179
Issue: 2
ISSN: 2168-6106
Publisher: American Medical Association  
Date Published: 2019-02-01
Start Page: 240
End Page: 246
Language: English
DOI: 10.1001/jamainternmed.2018.5748
PUBMED: 30508032
PROVIDER: scopus
DOI/URL:
Notes: Review -- Export Date: 1 March 2019 -- Source: Scopus
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