Overuse of Medical Services Common, Costly

Analysts are increasingly concerned about the overuse of medical care in which the potential harms outweigh the potential benefits. Overuse comes in all shapes and sizes, often including unnecessary or risky diagnostic and screening tests, use of procedures that are not needed or create unnecessary risk, and the use of medications inappropriately.

A large team of prestigious researchers from across the United States examined medical care in 2013, and identified areas in which overuse was most prevalent. Now, investigators have revisited their findings, which show that the situation is grim: overuse nearly doubled in several areas between 2014 and 2015.

The team looked for original research articles published in 2015 that discussed overuse of testing, overtreatment, and services. They found 821 articles that addressed the overuse of medical care, and considered 112 of these articles most relevant to their study.

Their findings are remarkable:

• Referrals to specialists, and for advanced imaging for simple headaches doubled.
• Unnecessary hospital admission for low-risk syncope doubled, and was frequently associated with adverse events.
• Thirty-four percent of patients who had colonoscopies were screened too often. Colonoscopy is associated with risks, and when patients are screened too often or early, it decreases access for unscreened patients.

Overtreatment was also common:

• One-quarter of patients with atrial fibrillation who were at low risk for thromboembolism received anticoagulation. Prescribers should use CHADS₂and CHA2DS₂-VASc scores to determine if young, healthy patients need anticoagulation.
• Clinicians failed to comply with guideline recommendations regarding testosterone replacement 94% of the time. With nearly 4% of men in their 60s now taking testosterone, and with the potential of testosterone to cause serious adverse events, it is time "to get with the guidelines." The Endocrine Society's guidelines areonline and free of charge.
• In patients who had experienced an opioid overdose, 91% re-started opioid treatment. Patients who overdose once have a significantly elevated risk of another overdose.
• Among patients with diabetes, clinicians provided treatment so aggressive that 61% were treated to potentially harmful low HbA_1clevels (<7%).

Questionable medical practices included treatment of acute low-back pain with cyclobenzaprine, and oxycodone/acetaminophen, both of which have been associated with harm to patients; use of molecular assays to test forClostridium difficile(C. Diff), which can lead to overdiagnoses of C. Diff; and serial follow-up of benign thyroid nodules, which very rarely become malignant.

Retail health clinicians can find a wealth of information about evidence-based care, tests, or procedures that are often ordered, but are duplicative, potentially harmful, and inappropriate interventions atChoosing Wisely. This site is dedicated to improving medical care, and also offers information that can promote informed conversations with patients.

This study appears ahead-of-print inJAMA Internal Medicine.