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Generally Unnecessary Use of Imaging Reduced for Two Medical Conditions

WILMINGTON, DE – The Choosing Wisely campaign to reduce clinical services with minimal benefits to patients appears to be paying off somewhat – at least for two imaging-related options.

An analysis published recently in JAMA Internal Medicine finds reduced use of imaging for headaches and cardiac imaging in low risk patients. Study authors, led by researchers from HealthCore in Wilmington, DE, note that reducing the use of unnecessary medical procedures and treatments is critical for controlling healthcare expenditures.

Choosing Wisely, initiated by the American Board of Internal Medicine, includes more than 70 lists of about 400 recommendations of frequently used medical practices or procedures that are of minimal clinical benefit to patients.

For this study, researchers opted to examine the frequency and trends of some of the earliest Choosing Wisely recommendations from 2012. Using medical and pharmacy claims from Anthem-affiliated Blue Cross and Blue Shield health care plans for about 25 million members, they focused on seven services:

  • Imaging tests for headache with uncomplicated conditions;
  • Cardiac imaging for members without a history of cardiac conditions;
  • Preoperative chest x-rays with unremarkable history and physical examination results;
  • Low back pain imaging without red-flag conditions;
  • Human papillomavirus (HPV) testing for women younger than 30;
  • Antibiotics for acute sinusitis; and
  • Prescription nonsteroidal anti-inflammatory drugs (NSAIDs) for members with select chronic conditions, i.e., hypertension, heart failure or chronic kidney disease.

The number of members with medical and/or pharmacy claims for the included low-value services was assessed quarterly over a two- to three-year span through 2013.

Only two of the services showed declines: Use of imaging for headache decreased from 14.9% to 13.4%, while cardiac imaging decreased from 10.8% to 9.7%.

On the other hand, results indicate that use of NSAIDs went up from 14.4% to 16.2%, and usually unnecessary HPV testing in younger women increased from 4.8% to 6.0%.

Changes in three other services were not significant. Antibiotics for sinusitis remained essentially stable, decreasing slightly from 84.5% to 83.7%. The already high use of pre-operative chest X-rays, 91.5%, and imaging for low back pain, 53.7%, showed no meaningful changes, according to the investigation.

Study authors caution that the research was based on administrative claims data, which doesn’t always adequately capture the clinical circumstances that led to a medical decision.

"The relatively small use changes suggest that additional interventions are necessary for wider implementation of Choosing Wisely recommendations in general practice,” study authors conclude. “Some of the additional interventions needed include data feedback, physician communication training, systems interventions (e.g., clinical decision support in electronic medical records), clinician scorecards, patient-focused strategies and financial incentives.”

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