Overdiagnosis and overtreatment as a quality problem: insights from healthcare improvement research

Armstrong, Natalie

doi:10.1136/bmjqs-2017-007571

Cited by 41 publications

(13 citation statements)

References 30 publications

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“…Other factors associated with the use of dipsticks such as history of falls are more likely associated with healthcare cultures of ‘prevention better than cure’ [1]. Ease of obtaining a urine sample may be the underlying reason for dementia patients being less likely to receive a dipstick rather than any clinical features.…”

Section: Discussionmentioning

confidence: 99%

“…These guidelines require implementation in hospital admission and emergency departments with ongoing measurement and evaluation of effectiveness. Stopping inappropriate or ineffective practices can be more challenging than implementing new ones, particularly for low-cost tests [1, 18]. The reasons why healthcare professionals continue with practices for which there is little or no evidence include individual beliefs, professional cultures and wider contextual influences [18].…”

Section: Discussionmentioning

confidence: 99%

“…The reasons why healthcare professionals continue with practices for which there is little or no evidence include individual beliefs, professional cultures and wider contextual influences [18]. Recommended methods to reduce overdiagnosis and overtreatment in quality improvement research [1] should be applied to UTI diagnosis in older adults. Such approaches include making healthcare patient-centred and responsive to an individual patient’s needs.…”

Section: Discussionmentioning

confidence: 99%

“…Overdiagnosis and overtreatment can be understood as a healthcare quality problem [1]. In the case of antimicrobial prescribing this is particularly important in order to reduce harm, promote stewardship and avoid inappropriate treatment.…”

Section: Introductionmentioning

confidence: 99%

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Overprescribing antibiotics for asymptomatic bacteriuria in older adults: a case series review of admissions in two UK hospitals

Rousham

Cooper

Petherick

et al. 2019

Antimicrob Resist Infect Control

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Background Overdiagnosis and overtreatment of urinary tract infection (UTI) with antibiotics is a concern. In older adults, diagnosis of UTI using near-patient urine tests (reagent strip tests, dipsticks) is advised against because the age-related increase in asymptomatic bacteriuria can cause false-positive results. Instead, UTI diagnosis should be based on a full clinical assessment. Previous research lacks systematic information on urine dipstick use in hospitals. The aim of this study was to examine the use of urine dipstick tests and microbiology among older adult hospital admissions in relation to recommended UTI diagnostic criteria. A further aim was to assess factors associated with the use of dipsticks. Methods A case series review of patients aged ≥70 years admitted to two NHS Trust hospitals in England. Records from 312 patients admitted in 2015 meeting inclusion criteria were selected at random. Results Of 298 complete patient records, 54% had at least one urine dipstick test recorded. 13% (21/161) of patients who received a urine dipstick test were diagnosed as having a UTI, only 2 out of these 21 cases had two or more clinical signs and symptoms. 60 patients received a second dipstick test, leading to 13 additional cases of UTI diagnosis. Dipstick tests were more likely to be performed on patients with a history of falls (OR 1.93, 95% CI:1.21, 3.07, p < 0.01), and less likely on those with dementia (OR 0.44, 95% CI: 0.22, 0.87, p < 0.05). The most common reason for testing was routine admissions policy (49.1% of cases), but these cases were predominantly in one hospital. Conclusions Use of urine dipstick tests was high among older adults admitted to hospitals. Most cases were asymptomatic and therefore received inappropriate antibiotic therapy. This paper highlights the need to implement new Public Health England diagnostic guidelines to hospital admission and emergency departments.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Overprescribing antibiotics for asymptomatic bacteriuria in older adults: a case series review of admissions in two UK hospitals

Rousham

Cooper

Petherick

et al. 2019

Antimicrob Resist Infect Control

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“…The value and epistemic authority of medicine is open to challenge as medicine has no epistemological essence ‐ there is no single medical model (Rose 2007). In the last decade concerns regarding ‘too much medicine’ and ‘over‐diagnosis and over‐treatment’ are increasingly surfacing in relation to specific conditions and practices (Armstrong 2018). While not necessarily straightforward to define, overdiagnosis and any subsequent overtreatment are terms generally used about instances in which a diagnosis is ‘correct’ according to current standards but the diagnosis or associated treatment has a low probability of benefitting the patient, and may instead be harmful (Moynihan et al .…”

Section: Conceptualising Uncertaintymentioning

confidence: 99%

Understanding and managing uncertainty in health care: revisiting and advancing sociological contributions

Mackintosh

Armstrong

2020

Sociology Health & Illness

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In this collection we revisit the enduring phenomenon of uncertainty in health care, and demonstrate how it still offers coherence and significance as an analytic concept. Through empirical studies of contemporary examples of health care related uncertainties and their management, our collection explores the different ways in which uncertainty may be articulated, enacted and experienced. The papers address a diverse range of healthcare contexts ‐ Alzheimer’s disease, neonatal surgery, cardiovascular disease prevention, cancer, addiction (use of alcohol and other drugs during pregnancy), mental health/disorders and medical education – and many tackle issues of contemporary relevance, such as an ageing population, and novel medical interventions and their sequelae. These empirical papers are complemented by a further theoretical contribution, which considers the role of ‘implicit normativity’ in masking and containing potential ethical uncertainty. By mapping themes across the collection, in this introduction we present a number of core analytical strands: (1) conceptualising uncertainty; (2) intersections of uncertainty with aspects of care; (3) managing uncertainty; and (4) structural constraints, economic austerity and uncertainty work. We reflect on the methodological and theoretical stances used to think sociologically about uncertainty in health care, and the strengths, silences and gaps we observe in the collection. We conclude by considering the implications of the insights gained for ‘synthesising certainty’ in practice and for future research in this area.

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Significance of Incidental Thyroid Findings in a Large Community‐based Lung Cancer Screening Cohort

Bertoni,

Schlegel,

Gillmore

et al. 2024

The Laryngoscope

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ObjectivesInvestigate incidental findings of neck pathology on lung cancer screening computer tomography scans and determine clinical relevance in a population of heavy smokers.MethodsA retrospective chart review was conducted utilizing a database of patients who underwent a chest computed tomography (CT) through a robust community‐based hospital lung cancer screening program in 2019 and 2020. Demographics, medical history, imaging reports, and any pathology results were analyzed.ResultsA total of 1738 patients received a lung screening scan during the study period. The median age of the patient population was 64 (range: 50–79), 886 (51%) were male, and 1599 (92%) were Caucasian. Ninety‐four (5.4%) were found to have neck findings on their CT report, including thyroid nodules, calcifications, heterogeneity or enlargements, pathologic appearing lymph nodes, or parathyroids. Forty‐two patients had evidence of follow‐up for their thyroid findings, and three of these ultimately underwent surgical intervention.ConclusionThe results of our study demonstrate that lung cancer screening chest scans can discover clinically relevant findings in the neck. The risks and benefits of screening needs to be thoroughly evaluated. Given the relatively low incidence of findings in this population, a prospective study in conjunction with screening questionnaire for symptoms may increase the yield of incidental findings.Level of Evidence3 Laryngoscope, 2024

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Overdiagnosis and overtreatment as a quality problem: insights from healthcare improvement research

Cited by 41 publications

References 30 publications

Overprescribing antibiotics for asymptomatic bacteriuria in older adults: a case series review of admissions in two UK hospitals

Overprescribing antibiotics for asymptomatic bacteriuria in older adults: a case series review of admissions in two UK hospitals

Understanding and managing uncertainty in health care: revisiting and advancing sociological contributions

Significance of Incidental Thyroid Findings in a Large Community‐based Lung Cancer Screening Cohort

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