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Physicians name top 5 areas of concern in pediatrics, family medicine and internal medicine

A study in The Archives of Internal Medicine has listed the top five activities in family medicine, internal medicine and pediatrics where the quality of care could be improved and costs of care could be reduced.

The study was developed by the National Physicians Alliance’s Promoting Good Stewardship in Clinical Practice, a project developed from a grant received from the American Board of Internal Medicine Foundation “to develop and disseminate five activity lists of evidence-based, quality-improving, resource-sparing activities that could be incorporated into the practices of primary care providers in family medicine, internal medicine and pediatrics.”

“Americans are concerned about the quality and cost of healthcare,” said project leader Stephen R. Smith, MD, in a NPA press release. “Unfortunately, some elements of the healthcare system include expensive practices that do not improve health and in some cases cause harm. Practicing responsible medicine means always doing what is best for the patient while being mindful that resources are finite and that doing more does not always mean better care. The National Physicians Alliance believes that every American deserves high quality and affordable healthcare.”

Selected NPA members responded to a survey in which they were asked to rate chosen clinical practice activities for their specialty based on how often they did the activity, the potential impact of the activity on quality of care and cost of care, the strength of evidence supporting the activity and how difficult or easy it was to do the activity.

The resulting top five activities for each specialty include:

  • Restrictions on when to order imaging for low back pain;
  • Elimination of routine antibiotics prescriptions for acute mild to moderate sinusitis;
  • Elimination of annual ECGs/cardiac screenings for low-risk patients;
  • Prescribe generics when beginning lipid-lowering drug therapy;
  • Tell patients not to use over-the-counter cough and cold medicines;
  • Recommend use of inhaled corticosteroids to control asthma; and
  • Stop using DEXA bone density scans to screen for osteoporosis in women under age 65 and men under age 70 who have no risk factors

The NPA plans on distributing its top five lists to members and will offer support, such as training videos, to have the recommendations implemented in practices.