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Limited gains seen against inappropriate care: study


By Ashok Selvam
Posted: December 26, 2012 - 2:45 pm ET
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Healthcare providers offering ambulatory services have made strides over the past 10 years in curbing undertreatment but still need improvement when it comes to overtreatment and misuse of healthcare services, according to a study published in the Archives of Internal Medicine.

“We found significant improvement in the delivery of underused care but more limited changes in the reduction of inappropriate care,” the paper read. “With the high cost of healthcare, these results are concerning.”

The paper, “Trends in the Overuse of Ambulatory Health Care Services in the United States,” was published online Monday. The authors aimed to measure how overuse and misuse of ambulatory services had changed during a 10-year period.

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Researchers compared the National Ambulatory Medical Care Survey's results from 1999 to 2009 and tracked 22 quality indicators. “Underuse” meant not providing an evidence-based treatment. “Overuse” meant providing a service that wasn't recommended. “Misuse” meant providing the wrong treatment, while “inappropriate care” included both misuse and overuse.

The study found providers showed statistically significant improvement in two of 11 overuse quality indicators. Researchers saw one indicator worsened, while eight didn't change. Researchers observed a decreased in the overuse of cervical cancer screenings for women older than 65 years, as well as a decrease in overuse of antibiotics in asthma exacerbations. Researchers noted an increase in the overuse of prostate cancer screenings for men older than 74.

Meanwhile, the paper showed statistically significant improvement in six of nine underuse quality indicators. Those six categories were the use of antithrombotic therapy for atrial fibrillation; use of aspirin in coronary artery disease; use of beta blockers in coronary artery disease; use of statins in coronary artery disease; use of beta blockers in congestive heart failure; and the use of statins in diabetes mellitus.

Finally, of the two misuse indicators, researchers saw a decrease in the proportion of patients with urinary tract infections who were prescribed an inappropriate antibiotic.

“Although there is continuing debate about what constitutes a reasonable cost of healthcare, there is growing momentum in delivering higher quality care that costs less,” the report read. “Reducing inappropriate care where patients clearly do no benefit and for which there may be added risk is certainly part of this stated goal.”


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