Medical exam overuse occurs when tests are ordered with little or no clinical benefit, increase spending without improving health outcomes or carry a risk of harm that outweighs the potential benefit of doing said exam.
This problem is driven by factors such as lack of knowledge about test utility, defensive medicine, financial incentives, and patient demand. Overuse leads to wasted healthcare resources and can result in the overtreatment of conditions that might never have caused harm.
EXAMPLES OF OVERUSE EXAMS
SINUS CT SCANS: Ordering CT scans for every case of uncomplicated acute sinusitis is often considered overused, as other treatments are more appropriate.
ALLERGY TESTING: Certain diagnostic tests for allergies, such as indiscriminate immunoglobulin G (IgG) or immunoglobulin E (IgE) testing, are frequently cited as overused
SOME CANCER SCREENINGS
PSA- While screening is important for some excessive or inappropriate screening can lead to the overdiagnosis of indolent cancers.
MAMMOGRAMS:
The United States Preventive Services Task Force (USPSTF) recommends biennial (every two years) screening mammography for women 70-74 and they are not recommended after 75
There's a great deal of waste and abuse in our Medicare system. Medicare waste refers to the inefficient or improper use of resources within the Medicare program, leading to unnecessary costs. It encompasses a range of issues, from excessive or unnecessary services to outright fraud. One area that is a huge issue is over-ordering of diagnostic tests and medications.
Concerns about over-ordering of diagnostic tests in seniors over 70 are significant and increasing. Over-ordering of diagnostic tests in seniors over 70 is a complex issue with significant consequences. Addressing this challenge requires a multi-disciplinary approach that includes educating both physicians and patients.
For example:
Mammograms for women over 72 with a history of normal screenings and no symptoms no longer need testing.
PSA testing for men over 70 is no longer recommended, depending on risk factors and history
- Increased Risk with Age: As individuals age, the likelihood of developing chronic conditions and being prescribed multiple medications rises significantly.
- Adverse Drug Events (ADEs): The risk of ADEs increases with the number of medications taken. These can range from minor side effects to serious drug-drug or drug-disease interactions.
- Falls and Cognitive Impairment: Polypharmacy is associated with a higher risk of falls, fractures, kidney impairment, frailty, and cognitive dysfunction.
- Reduced Quality of Life: Taking multiple medications can impact a senior's daily life, affecting their ability to participate in social activities or exercise due to side effects or complex dosing schedules.
- Multiple Healthcare Providers: Seniors often see multiple specialists, who may prescribe medications without full awareness of other medications the patient is taking.
- Chronic Conditions and Guideline-Driven Care: Guidelines for managing individual diseases often recommend specific medications, which, when applied to patients with multiple conditions, can lead to polypharmacy.
- Prescribing Cascade: Side effects from one medication can be mistaken for a new condition, leading to the prescription of another medication to address those side effects, creating a cascade of prescriptions.
- Automatic Refills and Lack of Review: Medications may be refilled automatically without regular review to ensure continued necessity.
- Patient Expectations: Patients may expect or even request medications for every ailment, contributing to over-prescribing.
- Marketing and Promotion: Pharmaceutical marketing and direct-to-consumer advertising can encourage patients to inquire about specific drugs, even if they aren't the best option.
- Deprescribing: This proactive process involves identifying and discontinuing or reducing the dose of medications that are potentially inappropriate, no longer necessary, or whose risks outweigh their benefits, according to the National Institute on Aging (.gov).
- Medication Reconciliation: This involves creating and maintaining an accurate and up-to-date list of all medications a patient is taking, including over-the-counter drugs, supplements, and traditional remedies, especially during transitions in care.
- Patient Education: Seniors and their caregivers need clear information about their medications, including purpose, dosage, administration, potential side effects, and risks of drug interactions.
- Involving Pharmacists: Pharmacists, particularly those with specialization in geriatric care, can play a crucial role in medication management, conducting reviews, identifying discrepancies, and educating patients.
- Shared Decision-Making: Discussions about medication use, including deprescribing, should involve the patient, family (if appropriate), and healthcare providers to align decisions with patient preferences and goals.
- Technological Aids: Tools like medication management apps, smart pill dispensers, and electronic health records can help improve adherence and simplify complex regimens, according to Washington State University.
- Policy and System-Level Changes: These include improving information and training for healthcare professionals, encouraging regular medication reviews, and promoting value-based payment models that reward deprescribing when appropriate.
- Open Communication: Effective communication between all healthcare providers involved in a senior's care is essential to avoid conflicting prescriptions and ensure a comprehensive understanding of the patient's medication regimen.
- Seamless Transitions of Care: Accurate medication reconciliation and clear communication during transitions (e.g., from hospital to home) are crucial to prevent medication errors and ensure continuity of care.
