Physicians' Persistent 'Overuse' of Care Continues
In the misuse measures group, the researchers found an increase in inappropriate medications in the elderly rose from 6.5% to 7.2%.
This suggests "there has been little change in the delivery of inappropriate ambulatory care in the past decade," they wrote.
The researchers indicated that developing guidelines to reduce inappropriate care is difficult because there are no publicly reported databases or easily searchable hospital claims data files. "If a patient has an acute myocardial infarction, all that may be needed to determine whether a patient appropriately received an aspirin is the discharge diagnosis, inpatient medication list, and discharge medications."
In an accompanying editorial, Rita Redberg, MD, of the University of California San Francisco Department of Medicine, noted "It took many years for our system to get to this current complex and dysfunctional state and will clearly take some years to make real improvements. In some ways, we are the victims of our own success, because these problems come from the many more technologies, procedures, and treatments that are now available as well as the many different financing schemes.
"It is only more recently that we are realizing how many people are also being harmed by overtreatment."
She pointed to last September's Institute of Medicine's report "Best Care at Lower Cost: The Path to Continuously Learning Health Care in America" as a helpful effort to reduce wasteful care.
"The IOM report cautions us that as we embrace advances in healthcare, we must remember that a number of what were thought to be advances turned out not to be beneficial, or even harmful, such as prostate specific antigen (PSA) screening or some breast cancer treatments."
Cheryl Clark is senior quality editor and California correspondent for HealthLeaders Media. She is a member of the Association of Health Care Journalists.
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