Experts Recommend Strategies to Minimize Overuse of Five Treatments, Including Antibiotics

Americas top healthcare experts are recommending a series of specific strategies to reduce five medical interventions or treatments that are commonly used but not always necessary.

In a paper released today by the Joint Commission and the American Medical Association-Convened Physician Consortium for Performance Improvement® (PCPI®), advisory panel work groups offer approaches to address the overuse of antibiotics for viral upper respiratory infections (URIs), over-transfusion of red blood cells (called appropriate blood management for purposes of the summit), tympanostomy tubes for middle ear effusion of brief duration, early-term non-medically indicated elective delivery, and elective percutaneous coronary intervention (PCI).

Overuse has been described as the provision of medical interventions or treatments that provide zero or negligible benefit to patients, potentially exposing them to the risk of harm. Sometimes overlooked or neglected as a leading contributor to problems with quality and patient safety, overuse of these medical treatments and interventions affects millions of patients. Overuse also drives up healthcare costs, with an estimated $1 billion spent annually on unnecessary antibiotics for adults with viral upper respiratory infections alone.    

The paper Proceedings from the National Summit on Overuse, provides detailed recommendations on curbing overuse of the five identified medical interventions or treatments, as well as an overview of the 2012 National Summit on Overuse that brought together representatives from 112 professional organizations and associations. The five advisory panel work groups that tackled the five areas of overuse are suggesting common strategies to inspire physician leadership, support a culture of safety and mindfulness, promote further patient education, remove incentives that encourage overuse, encourage further study and spur other professional organizations to collaboratively address overuse.

The advisory panel work groups are also recommending steps specific to each of the five areas targeted for reduction. Among the recommendations are:

 Antibiotic use for viral upper respiratory infections develop clinical definitions for viral and bacterial upper respiratory infections, align current national guidelines that are contradictory, partner with the U.S. Centers for Disease Control and Prevention (CDC), and initiate a national education campaign on overuse of antibiotics for viral upper respiratory infections.

 Appropriate blood management develop a tool kit of clinical education materials for doctors, expand education on transfusion avoidance and appropriate alternatives to transfusion, and develop a separate informed consent process for transfusion that communicates the risks and benefits.

 Tympanostomy tubes for middle ear effusion of brief duration develop performance measures for appropriate use of tympanostomy tubes, determine the frequency with which tympanostomy tubes are performed for inappropriate indications in otherwise healthy children, and focus national research on issues related to tympanostomy tubes, including the role of shared decision making with parents and other caregivers.

 Early-term non-medically indicated elective delivery standardize how gestational age is calculated, make the early elective deliveries indications and exclusion list as comprehensive as possible to improve clinical practice, and, educate patients and doctors about the risks of non-medically indicated early elective deliveries.

 Elective percutaneous coronary intervention encourage standardized reporting in the catheterization and interventional procedures report, encourage standardized analysis/interpretation of non-invasive testing for ischemia, focus on informed consent and promote patient knowledge/understanding of the benefits/risks of PCI, and provide public and professional education.

Overuse is a serious problem that involves many complex decisions between doctors and patients, says Mark R. Chassin, MD, FACP, MPP, MPH, president and CEO of the Joint Commission. The recommendations from the summit will raise awareness that will help both doctors and patients make better decisions going forward, and ultimately improve quality and patient safety.

The AMA is committed to improving health outcomes; this important work will help health care professionals ensure that the right patient gets the right treatment at the right time, says AMA president Ardis D. Hoven, MD. As part of our strategic focus on improving health outcomes, one of our goals is to contribute to the appropriate use of finite healthcare resources and this will help us achieve that goal.

Proceedings from the National Summit on Overuse is available at:

Source: Joint Commission, American Medical Association