Swedes Show That We Can Improve Imaging in Prostate Cancer

Gerald Chodak, MD


August 19, 2013

Can We Change Behavior?

The message from this study is that implementing a program can change behavior among doctors. We realize that throughout the United States -- not just in urology but in many other specialties -- many tests are ordered inappropriately. The question is, how do we change behavior? If we simply let doctors know how they are doing and compare that information with information from other doctors in their region, it may have a positive effect. While informing them of the things that they shouldn't do, we need to simultaneously reinforce the proper use of imaging so that patients who need these tests are not deprived of them.

The question is, why can't we do this in the United States? A program that the American Urological Association [is participating in,] called Choosing Wisely®, is trying to implement ways to improve quality care, but it doesn't seem to be as extensively implemented as the program that was implemented in Sweden. Of course, insurance companies could be the gatekeepers by mandating that tests that are ordered are processed by an internal organization to make sure that patients meet certain criteria. We now have awareness that some of the newer treatments for prostate cancer have to be documented as satisfying the necessary requirements so that patients receive on-label medication.

In the end, this is a great opportunity to lower healthcare costs and keep men from undergoing unnecessary treatments and tests that, in the long run, may be bad for them. Many men who receive scans are found to have abnormalities that result in more tests, and that drives up expenses even further. So, I applaud this effort and think that we need to be far more aggressive. Around the United States, there are many multispecialty groups or large urologic groups that have the opportunity to do the same thing. They can inform their participants about what they are ordering compared with what the rest of the group is ordering, and what treatments they are recommending compared with what others are recommending. In that way they have an opportunity to try to standardize and improve the quality of care. In the end, this is a great opportunity. It should have occurred much sooner, but now is better than never. I hope that we see other efforts aimed at trying to standardize prostate cancer management so that patients improve and costs go down.

I look forward to your comments. Thank you.


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