In our Sunday series we  get to you one of the popular article from our archives which lists 5 medical treatments that pose a risk of overuse. Do you agree? 

 

 

 

 

 

A big chunk of health care spending stems from healthcare professionals who order tests that yield little useful information or perform procedures that don’t make their patients better.

There could be a variety of reasons for this behaviour; some doctors could be simply ignorant about which procedures or tests are meaningful. Some professionals give in to pressure built up by patients yet others call in for unnecessary procedures to protect themselves from possible lawsuits. Amongst the overwhelming list of medical treatments which are overused, listed here are, the top five of them.

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1. Liberal blood transfusions

Restrictive blood transfusion strategy should be recommended over the liberal strategy as it is safer and the risk of nosocomial infections can be cut down by 20%. Certain complications like volume overload or transfusion reactions can be avoided if the restrictive blood transfusion strategy is followed. Blood transfusions should not be recommended for patients with gastrointestinal bleeding unless their hemoglobin levels are life-threatening.

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2. Inappropriate antibiotic use

Earlier this year, the BMJ reported that India is the world’s top consumer of antibiotics and a hotbed for drug evading bacteria. Without a clear indication of necessity, antibiotics need not be prescribed. Avoiding unnecessary use of antibiotics will not only limit antibiotic-resistant bacteria but, will also help the patient to avoid Clostridium difficile infection, which can lead to colectomy or even death. It is important to educate the patients about the appropriate use of the prescribed antibiotics.

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3. Knee surgeries

The numbers of knee associated complications are growing rapidly from the past decade and so are the surgeries for them. Most of the surgeries are focused to treat meniscus associated problems. But, surgery is rarely required for a degenerative meniscus tear in adults with osteoarthritis. Physical therapy should be the primary treatment option for such patients. Arthoscopic meniscectomy for a meniscal tear should be considered only when the patient’s symptoms fail to show any improvement with the physical therapy.

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4. Non-steroidal anti-inflammatory drugs (NSAIDs)

Overuse of NSAIDs for chronic conditions such as osteoarthritis and rheumatoid arthritis is increasing globally. Several clinical studies have demonstrated that these drugs may cause significant cardiovascular and gastrointestinal toxicity. The toxicity increases with the concomitant use of corticosteroids. Since NSAIDs help in reducing pain and inflammation, the patients tend to misuse the drugs for the mild conditions other than disease-related pain.

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5. Elective percutaneous coronary intervention

A cardiac revascularisation strategy that is overused is electric percutaneous coronary intervention. Patients undergoing this procedure are also prone to certain complications such as stent thrombosis, peri-procedural complications and long-term bleeding. Appropriate use criteria (AUC) are certain guidelines framed for physicians to evaluate the necessity of a cardiac revascularization surgery.

A proper diagnosis is important to evaluate the appropriateness of any treatment proceeding. For confronting the problem of medical treatment overuse, efforts have to be made to determine and frame strict guidelines to be followed both by the physicians and patients.

 

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This article was originally published on 16.8.17

 

References

1. L. Cavagna, R. Caporali et al., Overuse of Prescription and OTC Non-steroidal Anti-inflammatory Drugs in Patients with Rheumatoid Arthritis and Osteoarthritis. International Journal of Immunopathology and Pharmacology.2013; Vol. 26, no. 1,279-281

2. Daniel Morgan, Scott M. Wright et al., Update on Medical Overuse. JAMA Internal Medicine. 2014. DOI: 10.1001/jamainternmed.2014.5444. Accessed on 3 July 2017

https://www.researchgate.net/publication/267753348_Update_on_Medical_Overuse

3. Lars B Holst, Marie W Petersen et al., Restrictive versus liberal transfusion strategy for red blood cell transfusion: systematic review of randomised trials with meta-analysis and trial sequential analysis. BMJ 2015

4. Gillian Porter, Nathan Grills. Medication misuse in India: a major public health issue in India. Journal of Public Health. Vol. 38, No. 2, pp. e150–e157

5. Christopher Moriates. Overuse as a patient safety problem. Patient Safety Network. Acceessed on 3 July 2017. https://psnet.ahrq.gov/perspectives/perspective/164

6. Paul S. Chan,MD,MSC; Manesh R. Patel, MD. Appropriateness of Percutaneous Coronary Intervention. JAMA. 2011;306(1):53-61.