From: mha23x@gmail.com   
      
   Doctors Repeatedly Overprescribe Antibiotics And Narcotics ➡ "We need to   
   start concentrating on high-value care.”    
      
   *****    
      
   Doctors Repeatedly Overprescribe Antibiotics And Narcotics    
   “We need to start concentrating on high-value care.”    
      
      
    Dec 06, 2016    
    Lisa Rapaport    
      
   SELECTSTOCK VIA GETTY IMAGES    
   Twenty-seven percent of doctors identified overprescribing antibiotics, and   
   7.3 percent of doctors identified overprescribing opioids and narcotics as   
   common problems in a new survey.    
   Antibiotics and narcotics are often prescribed when they aren’t the best   
   option for patients and may do more harm than good, a survey of U.S.   
   physicians suggests.    
      
   The survey asked doctors to identify treatments that they see routinely used   
   despite guidelines recommending against the interventions and little or no   
   value for patients.    
      
   Overuse of antibiotics topped the list, with 27 percent of doctors identifying   
   this as a common problem. Prescribing narcotics and opioids for chronic pain   
   was another treatment of limited value, according to 7.3 percent of physicians   
   surveyed.    
      
   “We need to start concentrating on high-value care,” said lead study   
   author Dr. Amir Qaseem, vice president of clinical policy and chair of the   
   high value care task force for the American College of Physicians.    
      
   This isn’t just about money.    
      
   “The value of any intervention is when you look at the benefits and harms   
   and cost together,” Qaseem said in a telephone interview.    
      
   “For example, HIV treatment is very expensive but that doesn’t mean it’s   
   low value because it’s very effective,” Qaseem added. “Antibiotics can   
   be very cheap but they can be low value because they often aren’t   
   necessary.”    
      
   His team’s findings, from an online survey completed by 1,582 doctors, were   
   published online December 5th in Annals of Internal Medicine.    
      
   Participants were asked to identify the two treatments they most often   
   observed being used for patients that were unlikely to offer high value.    
      
   Overuse of aggressive care in patients with limited life expectancy was   
   identified as a problem by 8.6 percent of participants, making it second only   
   to overuse of antibiotics.    
      
   This mostly included life-support measures near the end of life such as   
   feeding tubes, intubation and resuscitation; treatments to prevent long-term   
   complications in patients with little time left to live, such as dialysis or   
   invasive heart procedures;    
   and chemotherapy for patients with advanced or metastatic cancer.    
      
   About 5 percent of doctors also identified overuse of dietary supplements   
   including vitamin D, niacin, fish oil, calcium, multivitamins and folic acid.    
      
   Roughly 5 percent of doctors also cited overuse of statins and other   
   cholesterol-lowering medications in the elderly or to prevent health problems.    
      
   Other low-value interventions cited in the survey include invasive cardiac   
   procedures, diabetes treatments other than the drug metformin, and overuse of   
   bisphosphonates to treat osteoporosis, and over-managed or inappropriately   
   controlled blood pressure.    
      
   One limitation of the study is its cross-sectional design and self-reported   
   survey data, which makes it impossible to assess how closely the results   
   mirror actual overuse of low value interventions in the real world, the   
   authors note.   
      
   Even so, the results suggest that general internists are aware of clinical   
   guidelines and on board with the concept of avoiding low-value care, said Dr.   
   David Levine, a researcher at Brigham and Women’s Hospital and Harvard   
   Medical School in Boston who    
   wasn’t involved in the study.    
      
   “Clinicians who stray from guidelines may, or may not, have good reasons for   
   doing so,” Levine said by email. “The guidelines may not be applicable to   
   the patient in front of them, or they may not realize the newest   
   recommendations now counsel    
   against a treatment or procedure they learned in medical school.”    
      
   Patients shouldn’t be shy about questioning doctors, said Dr. Sharon Levine,   
   executive vice president of The Permanente Federation at Kaiser Permanente in   
   California.    
      
   “Every one of us should feel comfortable asking any one of a series of   
   questions when a physician proposes a therapy,” said Levine, who wasn’t   
   involved in the study. She listed them: “Why are you recommending this   
   treatment? What are the    
   potential risks associated with it, and what is the likely benefit? Are there   
   other approaches you considered, including no treatment? And what would be the   
   risks and benefits compared to what you are recommending? What should I look   
   for in terms of side    
   effects or adverse reactions?”    
      
   “These types of questions promote a healthy dialogue about the probability   
   that a recommended therapy will result in an outcome that is high value for   
   the patient,” Levine added by email.    
      
   Also on HuffPost    
      
   5 Ways Doctors Avoid Getting Colds    
      
   More: opioid epidemic antibiotics    
      
      
   http://m.huffpost.com/us/entry/us_5846f467e4b0fe5ab69322e0    
      
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