This article is more than 5 years old. Information may no longer be current.

ACP: Physicians commonly prescribe low value treatments

Internal medicine physicians often prescribe medications, such as antibiotics, narcotics and opioids, that are not beneficial to patients despite clinical guidelines advising against routine use of such treatments, according to study results published in Annals of Internal Medicine.

“The health care system in the United States underperforms on most quality markers compared with its international counterparts, despite U.S. health care spending having reached an unsustainable level ($3.0 trillion annually),” Amir Qaseem, MD, FACP, PhD, vice president of clinical policy at ACP and chair of ACP’s High Value Care Task Force, wrote. “The [ACP] defines care as ‘high value’ when potential benefits of an intervention outweigh potential harms and costs.”

The ACP administered a survey via email to 5,000 randomly selected ACP member physicians. The survey asked participants to list two treatments commonly used by internists that are unlikely to provide high value to patients.

A total of 1,582 internists (32.3%) responded to the survey. Respondents were excluded for either identifying diagnostic procedures or not seeing patients in practice, resulting in a final survey population of 1,130 (22.6% of recipients). A majority of respondents were white, male and aged older than 40 years. In addition, most participants practiced in outpatient facilities and specialized in general internal medicine.

The researchers found 15 therapeutic interventions that participants reported as often being used in clinical contexts without providing high value treatment. Among those interventions, overuse of antibiotics was the most strongly agreed upon (27.3%). Following antibiotics was overuse of nonpalliative care in patients with limited life expectancy (8.6%) and pharmacologic treatments, mainly narcotic and opioids, for chronic pain management (7.3%).

Due to the cross-sectional and self-reported nature of the survey, as well as many respondents naming diagnostics rather than therapies, these data may not consider all overused or misused interventions, according to Qaseem.

“While many current clinical guidelines recommend appropriate care, the results of this survey may reflect intrinsic motivations to err on the side of treatment rather than ‘doing nothing,’” he said in a press release. “However, as health care shifts to a value-driven system, this study shows that doctors are willing to critically assess their own clinical practice.”

Qaseem points to ACP’s High Value Care recommendations to aid both clinicians and patients in understanding the value of tests and treatments in order to eliminate useless practices, while improving health and avoiding harms. – by Alaina Tedesco

Disclosure: Qaseem reports no relevant financial disclosures.