Slow Progress on Curbing Wasteful, ‘Low-Value’ Health Care Practices: Study

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As health care budgets get tighter across the United States, there’s been a renewed focus on ridding the system of procedures that give patients little real benefit for the time and money spent.

Now, a new study suggests that the use of at least three health care services deemed to be “low value” have dropped over the past few years. However, there were only slight decreases — and even increases — in the use of many other low-value services, the report found.

In 2009, the National Physicians Alliance piloted an effort called the Choosing Wisely Campaign, aimed at cutting overuse and waste out of the health care system. The campaign lists hundreds of widely used medical practices and procedures that experts say are of little clinical good to patients.

In the new study, a team led by Abiy Agiro, of HealthCore in Wilmington, Del., examined seven health services deemed by the campaign to offer minimal benefit to patients.

The seven services were: imaging tests for uncomplicated headache; heart imaging for people without a history of heart conditions; pre-operative chest X-rays for patients without an unusual history and physical exam results; low back pain imaging without “red-flag” conditions; human papillomavirus (HPV) testing for women younger than 30; antibiotics for acute sinusitis; and the use of prescription nonsteroidal anti-inflammatory drugs (NSAIDs) painkillers — drugs such as ibuprofen and naproxen — for people with certain chronic conditions such as high blood pressure, heart failure or chronic kidney disease.

The investigators then looked at medical and pharmacy claims from Anthem-affiliated Blue Cross and Blue Shield health care plans, encompassing about 25 million members.

Agiro’s team found that, since 2012, the use of imaging for headache fell from 14.9 percent to 13.4 percent, heart imaging decreased from 10.8 percent to 9.7 percent, and antibiotics for sinusitis dropped slightly from 84.5 percent to 83.7 percent.

However, there were no significant changes in the use of pre-operative chest X-rays (91.5 percent) or imaging for low back pain (53.7 percent), while use of prescription NSAIDs actually rose from 14.4 percent to 16.2 percent and HPV testing in younger women increased from 4.8 percent to 6 percent.

According to the study authors, all of this suggests that “additional interventions are necessary” to curtail the use of many “low value” interventions and curb waste. They suggest that better communication training for doctors, strategies focused on patients and financial incentives might help change the situation.

The study was published online Oct. 12 in the journal JAMA Internal Medicine.

Writing in a journal editorial, David Howard of Emory University and Dr. Cary Gross of Yale University School of Medicine said doctors may also need more data to help support decisions they make every day.

“Instead of asking, ‘Does evidence affect [clinical] practice?’ we ought to be asking, ‘How can we produce more of it?,’ ” the two experts wrote.

More information

Here’s where you can learn more about Choosing Wisely.

Source: HealthDay

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