Overdiagnosis paradigm: not suitable for decreasing the overuse of antibiotics

Abstract

This paper summarises the discussion during the workshop on ‘Overdiagnosis and overtreatment of infectious diseases in general practice. How and where to break the endless loop?’ The workshop was organised as part of the overdiagnosis conference carried out in August 2018 in Copenhagen, Denmark. During the workshop, participants from all over the world reflected on the challenges of embracing the overdiagnosis paradigm as a tool to advance understanding and to find solutions to the unnecessary use of antibiotics in primary health care. It was concluded that the narrow view of the overdiagnosis paradigm does not provide theoretical resources to address the problem of the inherent connection between diagnostic error and treatment decision. In contrast to the overdiagnosis paradigm, the too much medicine paradigm is an umbrella term suitable to frame actions that recognise the complexity of the decision-making process during the consultation and its impact on overtreatment.

Diagnosis and treatment of stroke associated pneumonia: Qualitative exploration of clinicians’ practice

“…This result was in line with a previous study that compared the physicians' diagnosis with algorithmic, adjudicated diagnostic criteria for SAP and found that clinicians tend to over-diagnose SAP compared to algorithmbased approaches [16]. Overdiagnosis and overtreatment of SAP inevitably lead to serious repercussions such as excessive and unnecessary antibiotics usage in stroke patients, which often considered the main driver for bacterial resistance and also associated with and increase the economic burden on the patients [28,29]. Clinicians are guided to treat SAP as early as possible.…”

Antibiotic deprescribing: Spanish general practitioners’ views on a new strategy to reduce inappropriate use of antibiotics in primary care

“…However, discontinuing an unnecessary antibiotic course is seldom carried out in routine clinical practice because most physicians are concerned about hypothetical negative consequences of discontinuation. Fear of complications is one of the main reasons doctors feel reluctant to stop an antibiotic course despite knowing that this is no longer needed [ 28 ]. Notwithstanding this, only 12% of the respondents considered that the AD practice could lead to more complications and hospital admissions.…”

A qualitative assessment of the diagnosis and management of ventilator-associated pneumonia among critical care clinicians exploring opportunities for diagnostic stewardship

“…15,26,27 HCPs acknowledge that while the pressure to 'do something' can be consequential with regard to exacerbating antibiotic resistance, perceived failure to provide care to a patient can be equally if not more devastating. 10 To overcome this, acknowledging the lack of a gold standard for VAP diagnosis but arming clinicians with outcomes of short course (1-3 days) of antibiotic treatment 15,28 based on clinical criteria (and not necessarily culture results) could be a potential opportunity to limit both unnecessary culturing and antibiotic use.…”

“…8 Although diagnostic stewardship interventions are being increasingly implemented, accounting for clinician beliefs and behavioral norms in intervention design is important to maximize intervention uptake and impact. 9,10 We studied healthcare provider (HCP) practices and perceptions of challenges associated with VAP diagnosis, and we sought to identify opportunities for diagnostic stewardship.…”