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2018 Update on Medical Overuse.

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Medical overuse, including unnecessary tests and treatments, is common and can harm patients. A review of 2017 research highlights practices with no benefit, enabling clinicians to improve patient care.

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Area of Science:

  • Health Services Research
  • Clinical Practice Improvement
  • Medical Economics

Background:

  • Medical overuse is a significant problem in healthcare, leading to patient harm and increased costs.
  • Identifying and understanding overuse is crucial for improving healthcare quality and efficiency.

Purpose of the Study:

  • To identify and highlight original research articles from 2017 most relevant to understanding medical overuse in adult care.
  • To appraise the quality, clinical relevance, and impact of identified articles on medical overuse.

Main Methods:

  • A structured review of English-language articles published in 2017.
  • Examination of tables of contents of high-impact journals for articles related to medical overuse.
  • Appraisal of manuscripts for originality, methodologic quality, scope, clinical relevance, and impact.

Main Results:

  • 111 highly relevant articles on medical overuse were identified from 1446 initially screened.
  • Common examples of overuse include: unnecessary electrocardiograms (22% in low-risk patients), lipid monitoring with little impact on care, and overdiagnosis of cancer causing patient anxiety.
  • Ineffective or harmful interventions identified include: calcium/vitamin D for hip fracture prevention, pregabalin for sciatica, antipsychotics in hospice care, robotic-assisted nephrectomy, and high-sensitivity troponin testing with false positives.
  • A significant proportion of patients diagnosed with asthma (one-third) lacked evidence for the condition.
  • Restructuring electronic health records reduced low-value tests by over 50% (from 31.3 to 13.9 per 100 patient visits).

Conclusions:

  • Many current medical practices represent overuse, offering no benefit and potentially causing harm.
  • Inappropriate use of services is prevalent, necessitating a re-evaluation of clinical guidelines and practices.
  • Healthcare professionals can improve patient care by reviewing these findings and applying them to their clinical practice.