Setting a research agenda for medical overuse

Abstract

Although overuse in medicine is gaining increased attention, many questions remain unanswered. Dan Morgan and colleagues propose an agenda for coordinated research to improve our understanding of the problem Daniel J Morgan associate professor 1 , Shannon Brownlee writer 2 , Aaron L Leppin postdoctoral research fellow

Mapping the drivers of overdiagnosis to potential solutions

“…Avoid certain tests or screening tests 11 35 Less frequent screening tests Targeted screening tests (eg, limit screening to well defined high risk population) 9-35 - [37][38][39][40] Inform patients of benefits and harms of screening Raise threshold for "positive" screen or recall and biopsy [26][27][28][29][30][31][32][33][34][35][36][37][38][39] Change radiological advice drivers of overdiagnosis and overuse 9 23 overdiagnosis and overuse frequency and best methods to quantify the problem undiagnosing and deprescribing 3 deliberative and qualitative methods (including community juries) to inform policy and other decisions [23][24][25][26][27][28][29][30][31][32][33][34][35][36] evaluating responses to overuse, including communication …”

“…Biased reporting by media-eg, reporting lack of care more than underdiagnosis and overdiagnosis [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] Health system…”

“…Hard to do nothing rather than something [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] Overemphasis on diagnosis 20 Problem based learning approach leads to shotgun approach to diagnosis, rewards unusual or rare diagnoses, and contributes to overtesting and overdiagnosis, with an emphasis on avoiding omission errors Poor knowledge of patient preference and shared decision making 23 Improper weighting of absolute v relative risk Lack of professional self confidence or knowledge of harms Interventions to reduce overuse and overdiagnosis:…”

Preparing for a paradigm shift in aging populations: listen to the oldest old

“…Polypharmacy is especially prevalent in care of older people; in developed countries, almost 30% of patients aged 65 years and older are prescribed five or more drugs (Qato et al, 2008). Reasons for this over-prescription include the providers’ belief that more care is better, the providers’ poor knowledge of patient preference, and patients’ desire for reassurance (Morgan et al, 2015). Furthermore, technological medical advancements and physicians’ cure-oriented training have blurred the boundaries of medicine.…”

Defensive medicine in the emergency department. The clinicians’ perspective

“…1 The media play a pivotal role in this vicious circle, giving increasing strength to sensationalism and underlining with special emphasis the news about malpractice (although seldom confirmed), or else disseminating questionable information about new and phenomenal treatments, which obviously rises patients' expectations. 2 The overuse of medical services, defined as care in the absence of a clear medical basis for use or when the benefit of therapy does not outweigh risks, 3 is regarded as a growing problem in Western countries, accounting for up to 30% of all delivered care. [4][5][6] Incidentally, it is has also been acknowledged that medical overuse carries a higher risk of morbidity and mortality.…”