Physicians' Persistent 'Overuse' of Care Continues

Clinicians are getting better at providing patients with appropriate care, such as assuring coronary disease patients receive aspirin, beta blockers and statins. But they've done a poor job in reducing unnecessary, overused care, such as screening men 75 and older for prostate cancer, or screening women 66 and older for cervical cancer.

Those are conclusions in a special "Less Is More" paperpublished this week in JAMA Internal Medicine by Minal Kale, MD, of Mt. Sinai School of Medicine and research colleagues at the University of California San Francisco and San Francisco Veterans Affairs Hospital.

"In our examination of ambulatory health care services over 10 years, we found an improvement in six of nine measures of underuse (care) but (an improvement in) only three of 13 measures of inappropriate care (both overuse and misuse)," the researchers wrote.

They added that they find "considerable room for improvement in most of our overuse measures, a space in which the dual goals of high quality and reduced costs can be met."

For example, though there is good evidence that prostate cancer screening in elderly men and the infirm is not beneficial, "it continues to be performed at alarming rates. Despite being easily measured, this practice has not been evaluated as a potential performance measure or adopted by the Healthcare Effectiveness data and Information Set (HEDIS)."