Update on Medical Overuse Highlights Practices That May Harm More Than Help
Lipid testing common among statin-treated patients but rarely affects care.
A recent review published in JAMA Internal Medicine highlights the continued overuse of certain medical services and the increase in both patient harm and healthcare costs associated with these practices.
The review, which was the fifth annual update discussing medical care overuse, aimed to identify and highlight research articles and literature published in 2017 related to medical overuse in adult patients. Of the total 1446 articles identified, 910 addressed medical overuse and, of these, 111 were considered to be the most relevant due to their originality, methodologic quality, and scope. The final 10 articles were chosen by author consensus.
"These 10 most relevant studies revealed 3 major themes related to overuse: overenthusiasm for new services driving overuse, new evidence exposing previously accepted practices as overuse, and methods to limit unnecessary care," the study authors stated. Examples of medical overuse driven by overenthusiasm for new services included increased use of robotic surgery, prescribing gabapentinoids (gabapentin and pregabalin) inappropriately, and increased reliance on high-sensitivity troponin testing in patients presenting to the emergency department.
Other important findings of the study included: unnecessary electrocardiograms and the cascade of services they lead to, lipid panel testing rarely affecting care in patients treated with statins, anxiety and criticism faced by patients who were overdiagnosed with cancer and not seeking treatment, lack of association between calcium and vitamin D supplementation and reduction in hip fracture (relative risk, 1.09; 95% CI: 0.85, 1.39), lack of sciatica symptom improvement and an increase in adverse event risk in patients taking pregabalin, increased severity of delirium and increased risk of death (HR: 1.7; P=.003) in hospice patients taking antipsychotic medications, and one-third of patients diagnosed with asthma having no evidence of the condition.
“Many current practices were found to represent overuse, with no benefit and potential harms,” the study authors concluded. They added, “Reviewing these findings and extrapolating to their patients will enable healthcare professionals to improve the care they provide.”References:
Morgan DJ, Dhruva SS, Coon ER. 2018 Update on Medical Overuse. JAMA Internal Medicine. 2018. DOI: 10.1001/jamainternmed.2018.5748.