(May 24, 2011 - Insidermedicine)

Less is more when it comes to some aspects of healthcare delivery, according to research published in the Archives of Internal Medicine. A multidisciplinary group of primary care physicians have identified twelve things primary care physicians can do to improve care, and most involve avoiding certain tests or treatments.

Researchers representing The Good Stewardship Working Group of the National Physicians Alliance (NPA) aimed to identify activities in family medicine, internal medicine, and pediatrics where the quality of care could be improved. The Working Group included members of each of these three specialties, and together they agreed that an ideal activity would be one that was common in primary care practice, that was strongly supported by evidence, and that would lead to significant health benefits and reduce risks, harms, and costs. Once they developed a list of activities that met these criteria, they assessed physician support of these activities by conducting one round of field testing with 83 primary care physicians and a second round with an additional 172 physicians.

Finally, the investigators came up with the following list of activities, all of which were strongly supported by their field testers:

•    Don’t do imaging for low back pain within the first six weeks unless red flags, such as progressive neurological deficits, are present

•    Don’t routinely prescribe antibiotics for acute mild to moderate sinusitis unless symptoms (which must include purulent nasal secretions AND maxillary pain or facial or dental tenderness to percussion) last for 7 or more days OR symptoms worsen after initial clinical improvement

•    Don't order annual ECGs or any other cardiac screening for asymptomatic, low-risk patients

•    Don't perform Pap tests on patients younger than 21 years or in women status post hysterectomy for benign disease

•    Don't use DEXA screening for osteoporosis in women under age 65 years or men under 70 years with no risk factors

•    Don't obtain blood chemistry panels (eg, basic metabolic panel) or urinalyses for screening in asymptomatic, healthy adults

•    Use only generic statins when initiating lipid-lowering drug therapy

•    Don't prescribe antibiotics for pharyngitis unless the patient tests positive for streptococcus

•    Don't obtain diagnostic images for minor head injuries without loss of consciousness or other risk factors

•    Don't refer OME [otitis media with effusion] early in the course of the problem

•    Advise pediatric patients not to use cough and cold medications

•    Use inhaled corticosteroids to control asthma appropriately

Today’s research highlights some key activities that physicians can do to improve care and lower healthcare costs for everyone.