Doctors prescribe fewer tests for better care

NEW YORK (Reuters Health) - Ordering fewer tests and prescribing fewer antibiotics will not only curb healthcare spending but also improve the quality of primary care, a large group of U.S. doctors said Monday.

After soliciting input from more than 250 members, the National Physicians Alliance (NPA) came up with 15 recommendations it believes will help doctors practice medicine more efficiently.

The group’s report, published in the Archives of Internal Medicine, follows concerns over the growing use of new technologies, such as CT scans, that in many cases don’t have a clear medical value.

The report lists five evidence-based recommendations in three areas: family medicine, internal medicine and pediatrics.

The gist of the advice? Leave well enough alone.

For instance, the group discourages the use of blood and urine tests in healthy people, because they will probably yield few results and end up costing a lot. (See Reuters Health story of May 16, 2011).

It also cautions against heart tests such as ECGs or CT scans in symptom-free, low-risk individuals, because there is scant evidence that spotting cholesterol buildups provides any benefit in these people.

In fact, people may end up with side effect from the expensive tests, including kidney problems, anxiety and a slightly increased cancer risk.

The NPA also recommends against imaging tests for lower back pain in the first six months, noting that such tests do not lead to better results.

For kids, the group urges doctors to hold off on antibiotics for a sore throat, unless the strep test comes back positive.

Most sore throats are caused by viruses, which don’t respond to antibiotics, and using the drugs unnecessarily may fuel the spread of drug-resistant bacteria and expose patients to side effects.

And according to the NPA, kids should not use over-the-counter cough or cold medicines, because there is little evidence that they work. Despite this, more than 10 percent of kids use these drugs.

The NPA plans to distribute its recommendations to its 22,000 members across the U.S. and hopes to gain support from consumer and patient safety groups.

According to the report, “Having such endorsements will help dispel the misconception that these clinical recommendations represent rationing and support the idea that often less is truly more.”

SOURCE: Archives of Internal Medicine, online May 23, 2011.