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Little change in overtreatment at doctors' offices
Monday, December 24, 2012
By Genevra Pittman
NEW YORK (Reuters Health) - Although some Americans are getting more of beneficial treatments that were underused in the past, including drugs for heart disease, others are still being overtested or overtreated for a range of conditions, according to a new study.
Researchers found U.S. doctors' offices made progress on six of nine "quality indicators" for recommended and underused therapies but only scaled back on two of 11 unnecessary and potentially harmful health services.
Those findings reflect a growing concern over skyrocketing health care costs - and the realization that doctors and hospitals are going to have to find places where services can be scaled back.
"We all know that we need to do something about it, and one component of the high health care costs is the overuse and misuse of therapies and interventions," said Dr. Amir Qaseem, director of clinical policy at the American College of Physicians.
It's not about getting rid of services that are too expensive, he told Reuters Health, but evaluating what current tests and treatments may offer little value for certain patients.
For example, two overuse indicators included in the new analysis are screening men age 75 and up for prostate cancer and screening women 75 and older for breast cancer.
"For men who are getting screened over the age of 75, the likely benefit doesn't happen within a patient's lifetime," Qaseem said, because prostate cancer is often very slow-growing. And that's assuming prostate specific antigen (PSA) tests are beneficial at all.
Regardless of a man's age, however, the tests can still lead to invasive biopsies that come with side effects such as a risk of incontinence and impotence.
"We really need to start looking at some of these services that may be harmful," added Qaseem, who wasn't involved in the new research.
The findings are based on nationally representative studies of adult care in outpatient offices, conducted by the Centers for Disease Control and Prevention. Data came from 79,083 office visits in 1998-1999 and 102,980 visits in 2008-2009.
During that span, the use of many recommended therapies improved. For example, 28 percent of people with coronary artery disease were given aspirin in 1998-1999, compared to almost 65 percent a decade later.
Likewise, the use of statins more than doubled in those same patients, from 27 percent to 59 percent. In people with diabetes, statin prescriptions increased from 12 percent to 36 percent.
However, there was little change in rates of unnecessary and overused services, including some types of cancer screening for older adults or x-rays and urine tests done as part of a general check-up.
Two of those overuse indicators improved: cervical cancer screening for women over 65 dropped from 3 percent to 2 percent, and unnecessary antibiotic prescribing for asthma flare-ups fell from 22 percent to 7 percent.
On the other hand, rates of prostate cancer screening for older men increased, from between 3 and 4 percent to almost 6 percent, according to findings published Monday in the Archives of Internal Medicine.
The lead author on the study from New York's Mount Sinai School of Medicine, Dr. Minal Kale, said the set of quality indicators her team used doesn't necessarily represent all tests and treatments provided in outpatient care.
And she added that the overuse of medical services is a complicated issue.
"Culturally, there's a lot of resistance to limiting access to health care services because it quickly becomes politicized," Kale told Reuters Health.
"The question about overuse really needs to come back to quality. It's about quality of the care that we're delivering to patients."
The goal, she said, is to "increase the value and the quality of our health care system while also paying attention to the costs."
SOURCE: http://bit.ly/LvmYaB Archives of Internal Medicine, online December 24, 2012.
NEW YORK (Reuters Health) - Although some Americans are getting more of beneficial treatments that were underused in the past, including drugs for heart disease, others are still being overtested or overtreated for a range of conditions, according to a new study.
Researchers found U.S. doctors' offices made progress on six of nine "quality indicators" for recommended and underused therapies but only scaled back on two of 11 unnecessary and potentially harmful health services.
Those findings reflect a growing concern over skyrocketing health care costs - and the realization that doctors and hospitals are going to have to find places where services can be scaled back.
"We all know that we need to do something about it, and one component of the high health care costs is the overuse and misuse of therapies and interventions," said Dr. Amir Qaseem, director of clinical policy at the American College of Physicians.
It's not about getting rid of services that are too expensive, he told Reuters Health, but evaluating what current tests and treatments may offer little value for certain patients.
For example, two overuse indicators included in the new analysis are screening men age 75 and up for prostate cancer and screening women 75 and older for breast cancer.
"For men who are getting screened over the age of 75, the likely benefit doesn't happen within a patient's lifetime," Qaseem said, because prostate cancer is often very slow-growing. And that's assuming prostate specific antigen (PSA) tests are beneficial at all.
Regardless of a man's age, however, the tests can still lead to invasive biopsies that come with side effects such as a risk of incontinence and impotence.
"We really need to start looking at some of these services that may be harmful," added Qaseem, who wasn't involved in the new research.
The findings are based on nationally representative studies of adult care in outpatient offices, conducted by the Centers for Disease Control and Prevention. Data came from 79,083 office visits in 1998-1999 and 102,980 visits in 2008-2009.
During that span, the use of many recommended therapies improved. For example, 28 percent of people with coronary artery disease were given aspirin in 1998-1999, compared to almost 65 percent a decade later.
Likewise, the use of statins more than doubled in those same patients, from 27 percent to 59 percent. In people with diabetes, statin prescriptions increased from 12 percent to 36 percent.
However, there was little change in rates of unnecessary and overused services, including some types of cancer screening for older adults or x-rays and urine tests done as part of a general check-up.
Two of those overuse indicators improved: cervical cancer screening for women over 65 dropped from 3 percent to 2 percent, and unnecessary antibiotic prescribing for asthma flare-ups fell from 22 percent to 7 percent.
On the other hand, rates of prostate cancer screening for older men increased, from between 3 and 4 percent to almost 6 percent, according to findings published Monday in the Archives of Internal Medicine.
The lead author on the study from New York's Mount Sinai School of Medicine, Dr. Minal Kale, said the set of quality indicators her team used doesn't necessarily represent all tests and treatments provided in outpatient care.
And she added that the overuse of medical services is a complicated issue.
"Culturally, there's a lot of resistance to limiting access to health care services because it quickly becomes politicized," Kale told Reuters Health.
"The question about overuse really needs to come back to quality. It's about quality of the care that we're delivering to patients."
The goal, she said, is to "increase the value and the quality of our health care system while also paying attention to the costs."
SOURCE: http://bit.ly/LvmYaB Archives of Internal Medicine, online December 24, 2012.
Reuters Health
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