New study is further endorsement of New Zealand’s Choosing Wisely campaign

The Council of Medical Colleges says a new study that found hundreds of thousands of patients in the US state of Washington received unnecessary tests, procedures and treatments is further endorsement of New Zealand’s Choosing Wisely campaign.

The campaign encourages health professionals to talk to patients about unnecessary tests, treatments and procedures so patients can make an informed choice. Choosing Wisely is run by the Council, in partnership with the Health Quality & Safety Commission and Consumer New Zealand, with wide support from the health sector.

In First, Do No Harm: Calculating Health Care Waste in Washington State, published this month, the Washington Health Alliance used Milliman's MedInsight Waste Calculator  to analyse 47 common treatment approaches known by the medical community to be overused.

More than 45 percent of the health care services examined were determined to be low value (likely wasteful or wasteful, as defined by the national Choosing Wisely® programme). These medical tests and procedures have been shown to provide little benefit in particular clinical scenarios and, in many cases, have the potential to cause physical, emotional or financial harm to patients.

Approximately 1.3 million people received one of the 47 services between July 2015 and June 2016, with almost half receiving a low value service. This amounts to an estimated $US282 million in wasteful spending.

The calculator’s algorithms look at the frequency and cost of common treatment approaches known to be overused, such as prescribing medications, screening, diagnostic testing, preoperative evaluation, and routine monitoring and follow up.

As well as identifying potentially wasteful services, the calculator also defines services with a degree of appropriateness for care in light of clear recommendations from national medical societies and other nationally vetted sources.

The study found 36 percent of spending on the health care services examined went to low value treatments and just a handful of services accounted for millions of dollars of waste in the state.

Eleven of the 47 measures accounted for 93 percent of the low-value services and 89 percent of the estimated spend.

1. Too frequent cervical cancer screening in women
2. Preoperative baseline laboratory studies prior to low-risk surgery
3. Unnecessary imaging for eye disease
4. Annual EKGs or cardiac screening in low risk, asymptomatic individuals
5. Prescribing antibiotics for acute upper respiratory and ear infections
6. PSA screening
7. Population-based screening for OH-Vitamin D deficiency
8. Imaging for uncomplicated low back pain in the first six weeks
9. Preoperative EKG, chest x-ray and pulmonary function testing prior to low risk surgery
10. Cardiac stress testing
11. Imaging for uncomplicated headache

The Alliance says overuse could account for as much as one-third of total health care spending in the United States and being able to measure specific areas of waste in the health care system is an important step forward.

A survey of New Zealand doctors by the Council of Medical Colleges found half thought the provision of unnecessary tests, procedures or treatments was a serious or somewhat serious issue.

Council chair Dr Derek Sherwood says common factors across countries that contribute to health professionals ordering unnecessary services include patient expectation, lack of consultation time, overall uncertainty and fear of missing a diagnosis or malpractice concerns, reimbursement incentives, the way health professionals are taught and avoiding the challenge of telling patient they do not need specific tests.

‘The result can be care for patients that adds little or no value and may cause harm.

‘It is important to talk with patients about the care that is being recommended and use shared decision making. This includes listening to the patient about their experience of illness, their social circumstances, attitude to risk, their goals, values, preferences and support needs.’

Choosing Wisely encourages patients to ask their health professionals these four questions:

• Do I really need to have this test treatment or procedure?
• What are the risks?
• Are there simpler, safer options?
• What happens if I do nothing?

For more information visit www.choosingwisely.org.nz