Strategies to Avoid 5 Highly Overused Treatments

Leigh Page

July 16, 2013

In This Article

Concerns About Gray Areas

However, targeting overused treatments faces challenges in creating standardized approaches, according to William Golden, MD, professor of medicine and public health at the University of Arkansas for Medical Sciences in Little Rock.

Because all of these treatments are appropriate in some cases, "there is always going to be a gray zone, when it is a judgment call if they should or should not be used," he said. "So to actually go out and measure overuse is not so easy."

If an organization leaves too much of a gray zone, its recommendations will have little meaning, Dr. Goldman said.

Mariell Jessup, MD, president of the American Heart Association (AHA) and medical director of the Penn Medicine Heart and Vascular Center in Philadelphia, Pennsylvania, agreed there will always be exceptions to standardized treatments. "There are all kinds of nuances to guidelines, based on the many ways that patients present," she said. "Physicians will frequently say, what if the patient has this particular condition, isn't that going to affect what is done?"

For this reason, the summit chose a wide variety of experts and stakeholders to join its assessment panel for each of the 5 areas of overuse. Here are the areas each panel dealt with, followed by comments by each panel and by experts interviewed by Medscape Medical News who were not on the panels, and ending with each panel's recommendations.

Antibiotics for the Common Cold

Antibiotic use for viral upper respiratory infections is usually ineffective, Dr. Stream said. In many cases, differentiating viral from bacterial illness is difficult, and symptoms initially overlap.

Meanwhile, the treatment contributes to antibiotic resistance and cumulative overexposure, the panel noted. Antibiotics may also cause allergic reactions, gastrointestinal distress, immune system suppression, and adverse reactions with other medications.

Patients may pressure their physician for a prescription because it shows that something is being done for them, even though the best treatment is often just drinking plenty of fluids and resting, Dr. Stream said. He added that physicians then need to spend time educating the patient about appropriate use.

Recommendations: Develop clinical definitions for viral and bacterial upper respiratory infections, align current national guidelines that are contradictory, partner with the US Centers for Disease Control and Prevention, and initiate a national education campaign on overuse of antibiotics for viral upper respiratory infections.

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