Swiss internists list low-value tests, procedures

Last Updated: 2015-02-26

By Reuters Staff

NEW YORK (Reuters Health) - The "Choosing Wisely" campaign launched in the United States in 2012 is going global.

This week, the Swiss Society of Internal Medicine published a top 10 list of low-value healthcare activities that physicians and patients should question. They are:

1) Do not obtain imaging studies in patients with nonspecific low back pain.

2) Do not prescribe antibiotics for uncomplicated upper respiratory tract infection (URTI).

3) Do not perform the PSA test to screen for prostate cancer without a discussion of the risks and benefits.

4) Do not perform laboratory testing in patients with a clinical diagnosis of an uncomplicated URTI.

5) Do not continue pharmacological treatment of gastroesophageal reflux disease (GERD) with long-term acid suppression therapy without titrating to the lowest effective dose.

6) Do not routinely prescribe antibiotics for acute mild-to-moderate sinusitis.

7) Do not use antimicrobials to treat bacteriuria in immunocompetent older adults.

8) Do not routinely obtain radiographic imaging for patients who meet diagnostic criteria for uncomplicated acute rhinosinusitis.

9) Do not obtain preoperative chest radiography in the absence of a clinical suspicion.

10) Do not use dual-energy x-ray absorptiometry (DEXA) screening for osteoporosis in women younger than 65 or men younger than 70.

Dr. Kevin Selby of University of Lausanne, Switzerland, and colleagues published the list online February 23 in a research letter in JAMA Internal Medicine.

"In the short time since its April 2012 launch by the American Board of Internal Medicine Foundation, the Choosing Wisely campaign has affected more than 60 U.S. specialty societies. Now the campaign is becoming an international phenomenon," note Dr. Fiona Clement of the University of Calgary, Alberta, Canada and Dr. Blake Charlton, of the University of California, San Francisco, in a commentary. Participating countries include Canada, Australia, Germany, Italy, Japan, and the Netherlands.

"This rapid expansion is a heartening sign that there is increasing international sentiment against wasteful medical practices. However, actually decreasing wasteful and harmful health care will require both patient and physician commitment as well as objective evidence of effectiveness. We believe all top 5 lists should be accompanied by an implementation plan and should be evaluated and continuously monitored to assess their effect on low-value health care utilization," Drs. Clement and Charlton conclude.

SOURCE: http://bit.ly/1AaYNEp and http://bit.ly/1DZBQLQ

JAMA Intern Med 2015.