2019 Update on Medical Overuse: A Review

Area of Science:

• Health Services Research
• Medical Quality Improvement
• Patient Safety

Background:

• Medical overuse is a significant contributor to patient harm and healthcare waste.
• Identifying and reducing unnecessary medical interventions is crucial for improving patient outcomes and resource allocation.

Purpose of the Study:

• To review and synthesize key findings on medical overuse from high-impact literature published in 2018.
• To inform healthcare practitioners about prevalent issues of overuse and overtreatment to guide practice improvements.

Main Methods:

• A structured literature review of English-language articles on medical overuse.
• Appraisal of articles for methodologic quality, clinical relevance, and patient impact.
• Selection of the 10 most significant articles by author consensus from 1499 candidate articles.

Main Results:

• Overuse of diagnostic tests was identified, with examples including procalcitonin use in respiratory infections and incidentalomas on imaging.
• Overtreatment is common, with examples such as antibiotic overprescription in urgent care and ineffective treatment of subclinical hypothyroidism.
• Questionable services include opioids for chronic noncancer pain, stress ulcer prophylaxis in ICUs, and supplemental oxygen for normoxemic patients, with some interventions showing no benefit or increased harm.

Conclusions:

• Many medical tests are overused, and overtreatment is prevalent, leading to potential patient harm.
• Reducing overuse and unnecessary care is essential for enhancing patient care and minimizing medical waste.
• This review provides evidence-based insights from 2018 to support clinicians in optimizing medical practice.