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PCPs: Antibiotics, Opioids are the Top Low-value Treatments

By Tinker Ready  
   December 13, 2016

Overuse of antibiotics was the practice most commonly cited, accounting for more than one quarter of all responses, according to survey results.

The over-use of antibiotics and opioids is contributing to resistance and addiction, but not much else in the opinion of some primary care physicians.

Primary care doctors surveyed by the American College of Physicians listed the use of the two drugs among the four most common low-value treatments that are most frequently used by doctors, according to survey data published by the Annals of Internal Medicine cited in a letter on the appropriate use of therapeutic interventions to foster high-value care. The journal also published a review aimed at addressing the overuse of opioids.

Overuse of antibiotics was the practice most commonly cited, accounting for 27.3% of the responses. The overuse of nonpalliative care was cited by (8.6%) of the respondents and pharmacologic treatments (mostly narcotics and opioids) for chronic pain management (7.3%).

The list of low-value treatments also includes "aggressive non-palliative treatment in patients with limited life expectancy' and the use dietary supplements.

The study is based on an email survey of more than 1,100 ACP members. Most respondents were male, white, and older than 40 years.

Most focused on outpatient care and were general internists, versus internal medicine specialists. The authors note "many respondents struggled to identify therapies, instead naming diagnostics."

The authors write that the "goal of this observation is to promote thoughtful discussion among clinicians, patients, and policymakers about the value of care by balancing benefits, harms, and costs.'

A Critical Assessment, Focused Inward
Current clinical guidelines recommend appropriate care, but "the results of this survey may reflect intrinsic motivations to err on the side of treatment rather than 'doing nothing,'" lead author Amir Qaseem, MD, and chair of ACP's High Value Care Task Force, according to a statement announcing the study.

"However, as health care shifts to a value driven system, this study shows that doctors are willing to critically assess their own clinical practice."

The statement also points to ACP's High Value Care recommendations as a guide for doctors who want provide care that "improves health, avoids harms, and eliminates wasteful practices. Value is not merely cost. Some expensive tests and treatments have high value because they provide high benefit and low harm."

Tinker Ready is a contributing writer at HealthLeaders Media.


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