Source: JAMA Internal Medicine
What is this about?
This edition of Connections provides a recently published article that gives us a practical and systematic methodology and set of recommendations to reduce low value or “unnecessary” adult primary care use. The article contains a test of more than 409 specific recommendations representing 178 unique opportunities to make primary care more clinically efficient and to reduce the level of risk associated with medical care utilization. Many of these specific suggestions (also called “deintensification”) originated in the “Less is More” initiative of the Archives of Internal Medicine( now JAMA Internal Medicine), the National Physician’s Alliance’s Promoting Good Stewardship in Clinical Practice project, the American College of Physician’s High Value Care Initiative and the Choosing Wisely campaign of the American Board of Internal Medicine Foundation. Ideal targets for deintensification are ones in which a potential for immediate or long-term harm (eg, from polypharmacy, toxic effects, procedure complications, and unnecessary further workup) exceeds potential benefits. A supplemental publication with all the detail for implementation can be purchased on the JAMA website for $30.
Some of the specific recommendations include:
- Elimination of population-based screening for Vitamin D deficiency
- Avoiding concurrent use of opioids and benzodiazepines
- Avoiding imaging for low back pain
- Over-treatment of diabetes type 2 condition
- Limit screening in patients with less than 10 years of expected life
- Clinicians should not screen for cardiac disease in asymptomatic, low-risk adults with resting or stress ECG, stress echocardiography, or stress myocardial perfusion imaging.
Why is this important?
This document is important for five major reasons. First, this study report provides employee wellness professionals with a methodology for health plan monitoring and reducing the level of unnecessary primary care use by employees and their family members. Second, the article and its supplement provide a listing of 37 specific clinical situations that can be used to educate employees and their family members on how to avoid unnecessary primary care use and the associated iatrogenic risk. Third, given the growing COVID-19 use of health and hospital services, these insights can further reduce unrelated use of medical care to help prevent over-use of clinical services. Fourth, the authoritative and clear nature of these recommendations can be used to help reduce passive attitudes among health care consumers about their role in the health care process. Fifth, this information is a key element of health care literacy and helps to reverse the decades long decline in national health care literacy levels in our population.
What can you do with this document?
- First, download and skim the article to get a sense of the methodology and major findings.
- Next, order the Supplement from JAMA.
- Next, identify the 37 specific clinical recommendations and decide how they will be used with your population.
- Next, determine how your health plan(s) can use this information with your population.
- Then, plan your evaluation of the intervention you are proposing.
- Then, carry out the programming and the evaluation plan and report back to senior management on the findings from your use of the methodology.
- Finally, propose additional consumer education activities for the next program cycle.
In summary, this recent authoritative article and methodology from 4 key physician organizations provide a very useful framework and methodology for reducing unnecessary primary care use in working populations.
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I hope this tool helps you reach your wellness programming goals! Drop me a note and let me know if you found it to be helpful.