The overuse of some screening and diagnostic tests that fail to provide high-value, cost-conscious care plays an important role in the rising healthcare costs in the United States. Now more than ever, there is a push to recognize that more care is not necessarily better care.
In this month’s issue of the Annals of Internal Medicine, an ad hoc group of internists convened by the American College of Physicians (ACP) has identified a series of common clinical situations in which the use of screening and diagnostic tests does not reflect high-value care.
“Efforts to control expenditures should focus not only on benefits, harms, and costs but on the value of diagnostic tests—meaning an assessment of whether a test provides health benefits that are worth its costs or harms,” write Amir Qaseem, MD, PhD, MHA, from the ACP.
By consensus, the ACP committee members identified 37 clinical scenarios in which screening does not promote patient health. These include the following:
Ordering imaging studies for non-specific low back pain
Utilizing MRI instead of mammography to screen for breast cancer in women at average risk
Conducting serologic testing for suspected early Lyme disease
Obtaining electrocardiograms to screen for cardiac disease in patients at low to average risk for coronary artery disease
Performing coronary angiography in patients with chronic stable angina who have well-controlled symptoms on medical therapy, or who lack specific high-risk criteria on exercise testing
Assessing brain natriuretic peptide in the initial evaluation of typical heart failure findings
Routinely repeating echocardiography in asymptomatic patients with mild mitral regurgitation and normal left ventricular size and function
Obtaining exercise electrocardiogram for screening low-risk, asymptomatic adults.
Physician’s Weekly wants to know… Do you feel that part of the challenge is convincing patients that a test is not necessary? Are physicians in certain specialties scrutinized more than others when it comes to testing decisions (eg, ER physicians vs primary care)?