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Search results for "Overtreatment"
- Education and Training
Brownlee S, Garber J. Brookline, MA: Lown Institute; 2019.
Overprescribing is a common problem that contributes to patient harm. This report examines financial, clinical, and societal trends of medication overuse and inappropriate polypharmacy in older Americans. A culture of prescribing, deficits in information and knowledge, and fragmented care contribute to the problem. The report provides interventions to improve the safety of prescribing, including developing deprescribing guidelines, raising awareness among providers and patients about medication overload, and implementing team-based care models.
Journal Article > Study
Are more experienced clinicians better able to tolerate uncertainty and manage risks? A vignette study of doctors in three NHS emergency departments in England.
Lawton R, Robinson O, Harrison R, Mason S, Conner M, Wilson B. BMJ Qual Saf. 2019;28:382-388.
Risk aversion in clinical practice may lead to the ordering of unnecessary tests and procedures, a form of overuse that may pose harm to patients. Experienced clinicians may be more comfortable with uncertainty and risk than less experienced providers. In this cross-sectional study, researchers surveyed doctors working in three emergency departments to understand their level of experience and used vignettes to characterize their reactions to uncertainty and risk. They found a significant association between more clinical experience and less risk aversion as well as a significant association between more experience and greater ease with uncertainty. The authors caution that they cannot draw conclusions on how these findings impact patient safety. An accompanying editorial suggests that feedback is an important mechanism for improving confidence in clinical decision-making. A WebM&M commentary discussed risks related to overdiagnosis and medical overuse.
Journal Article > Commentary
Korenstein D. JAMA Intern Med. 2019;179:26-27.
Medical overuse can have negative ramifications for both patients and health care organizations. This commentary suggests that cognitive error is a key contributor to overuse. Rethinking evidence-based medicine education and improving physician skills in risk assessment and decision analysis can help reduce overuse. A PSNet perspective discussed medical overuse as a patient safety problem.
Kaiser Health News.
Journal Article > Study
Standard admission order sets promote ordering of unnecessary investigations: a quasi-randomised evaluation in a simulated setting.
Leis B, Frost A, Bryce R, Coverett K. BMJ Qual Saf. 2017;26:938-940.
Although standard admission order sets can enhance safety, they may lead to overtesting and overtreatment. In this simulation study, researchers found that when admission orders included the option of a nonindicated laboratory test, medical trainees and attending physicians were more likely to order those tests for a cardiac patient. A previous WebM&M commentary highlighted limits and pitfalls of order sets.
Pain Management and Prescription Opioid-related Harms: Exploring the State of the Evidence: Proceedings of a Workshop—in Brief.
Forstag EH; Committee on Pain Management and Regulatory Strategies to Address Prescription Opioid Abuse; Health and Medicine Division. Washington, DC: National Academy of Science; 2016. ISBN: 9780309451901.
Efforts to ensure safe pain management in the context of the opioid epidemic have focused on prescribing behaviors and policies. This publication reports on the results of a workshop convened to explore factors that contribute to opioid overuse and to identify areas for improvement that require further research.
Journal Article > Review
Patients' expectations of the benefits and harms of treatments, screening, and tests: a systematic review.
Hoffmann TC, Del Mar C. JAMA Intern Med. 2015;175:274-286.
This systematic review found that patients generally overestimate benefits and underestimate harms related to tests and treatments. The topics studied included cancer, surgery, cardiovascular disease, fetal–maternal medicine, and medications. These findings suggest that unrealistic patient expectations may contribute to health care overuse.
Chicago, IL: American Hospital Association Physician Leadership Forum; July 2014.
Res Social Adm Pharm. 2019;15:780-810.
Appropriate deprescribing can reduce the risks associated with polypharmacy, overuse, and accidental overdose. Articles in this special issue cover findings from a symposium discussing guidelines for safe discontinuation of medications and research needed to support further understanding of deprescribing practices.
Journal Article > Commentary
Judson TJ, Press MJ, Detsky AS. Healthc (Amst.). 2019;7:4-6.
Health care is working to provide high-value care and prevent overuse while ensuring patient safety. This commentary highlights the importance of educational initiatives, mentors, and use of clinical decision support to help clinicians determine what amount of care is appropriate for a given clinical situation.