More on Quality and Safety

Hospital-based primary care clinics ordering more unnecessary tests, researchers say

Researchers found physicians at hospital-based clinics are ordering excessive CT scans, MRIs, other services.

Beth Jones Sanborn, Managing Editor

According to a new study from Harvard Medical School and the David Geffen School of Medicine at UCLA, patients with back pain, headaches and upper respiratory infections are more likely to undergo unnecessary tests and medical services at hospital-based primary care clinics versus community-based clinics. The study was published Tuesday in JAMA Internal Medicine.

Researchers found that physicians at hospital-based clinics are sending too many patients to specialists, and ordering excessive numbers of CT scans, MRIs and X-rays, which may cast doubt on the value of care delivered at these facilities.

The authors compared 31,000 appointment records from two national databases over a 17-year time period looking at instances where patients sought treatment for upper respiratory infections, back pain and headaches. In order to zero in on those receiving unnecessary services, they excluded those with more complicated conditions and accounted for patients with underlying disorders or chronic illness.

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[Also: Physicians point to unnecessary tests, procedures as serious problem, spending driver]

Though they found antibiotics were prescribed at about the same rate across the board, people who sought treatment at hospital clinics saw an eight percent higher rate of referral for CT scans and MRIs, a 13 percent higher referral rate for x-rays and a 19 percent higher rate of referral for an evaluation by a specialist.

Those most likely to receive the unnecessary tests and services were either visiting hospital-based primary care clinics or seeing someone other than their normal doctor. Researchers said the indication there is that seeing multiple physicians may make unnecessary testing and services more likely. Overall, the subject creates concern as past research has shown a third of medical care could be categorized as unnecessary or "low value." This can lead to greater expense for patients and a spike in overall health care costs.

Twitter: @BethJSanborn