also supports the campaign. The medi- cal specialty societies who participated in developing the Choosing Wisely rec- ommendations are members of the AMA- convened Physician Consortium for Per- formance Improvement. TMA also par- ticipates in the workgroup.
The lists run the gamut, but all of the
recommendations start with or include “don’t” or “should not” or “avoid.” They include:
• Don’t routinely prescribe antibiotics for acute mild-to-moderate sinusitis unless symptoms last for seven or more days or symptoms worsen after initial clinical improvement.
• Don’t obtain imaging studies in pa- tients with nonspecific low back pain.
• Avoid nonsteroidal anti-inflammatory drugs in patients with hypertension or heart failure or chronic kidney dis- ease of all causes, including diabetes.
• For a patient with functional abdomi- nal pain syndrome, computed tomog- raphy (CT) scans should not be re- peated unless there is a major change in clinical findings or symptoms.
• Don’t perform positron emission to- mography, CT, and radionuclide bone scans in the staging of early breast cancer at low risk for metastasis.
Dr. Cassel says the listed services are not meant to be absolutes, rather guide- lines, adding that they include indica- tions or flags for when something may be appropriate. The lists are described as “things whose necessity should be ques- tioned and discussed” between physi- cians and patients. “The goal here is not to say, ‘You should never have any of these tests or treatments,’ but to say “You should have a conversation with your doctor about it.’ This is to get those conversations going,” she said.
The lists emerged from a consensus- building process among workgroups within each specialty. They looked at fac- tors such as the strength of the medical evidence available to evaluate a particu- lar service, the frequency of use, the eco- nomic impact, the effect on health care quality, and the ease of implementation of a recommendation.
Specialty societies identify overused procedures
As part of the Choosing Wisely campaign, nine specialty medi- cal societies compiled their lists of 45 tests and procedures and identified five diagnostic tests or treatments they think are overused and have not always shown to benefit patients. Those specialties societies are:
• American Academy of Allergy, Asthma & Immunology, • American Academy of Family Physicians, • American College of Cardiology, • American College of Physicians, • American College of Radiology, • American Gastroenterological Association, • American Society of Clinical Oncology, • American Society of Nephrology, and • American Society of Nuclear Cardiology.
Another 20 specialty societies are expected to release their
lists by early next year. Among them are the American Acad- emy of Hospice and Palliative Medicine, the American Acad- emy of Otolaryngology-Head and Neck Surgery, the American College of Rheumatology, the American Geriatrics Society, the American Society for Clinical Pathology, the American Society of Echocardiography, the Society of Hospital Medicine; and the Society of Nuclear Medicine.
December 2012 TEXAS MEDICINE 27
The NPA project formed the basis for
the American Academy of Family Physi- cian’s (AAFP’s) “Top Five” recommenda- tions. The organization will develop five more by the end of the year, says AAFP president and Spokane, Wash., family physician Glen R. Stream, MD. The idea was to target what he characterized as the low-hanging fruit, things that have strong scientific backing. The AAFP-approved recommendations limiting Pap smears and dual-energy x- ray absorptiometry scans, for example,
were derived, in part, from U.S. Pre- ventive Services Task Force guidelines, whereas those related to antibiotics and imaging use draw on independent re- search within the field.
Several factors may contribute to misuse of medical tests and procedures, Dr. Stream says. They include patient expectations, physician habits, a dearth of guidelines in some cases, or an over- abundance of emerging medical evi- dence in others that is simply too much for doctors to track.
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