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Chest x-rays, electrocardiograms, and Pap tests in low-risk patients are associated with further tests and procedures
Question clinique
Are chest x-rays, electrocardiograms, and Pap tests in low-risk patients associated with subsequent additional health care?
L’Essentiel
Low-value tests - screening tests in low-risk patients - such as chest x-rays and electrocardiograms (EKGs) in adults as part of an annual health examination and Papanicolaou (Pap) tests in women younger than 21 years or older than 69 years, are associated with more visits to specialists, more diagnostic tests, and more procedures. 2b
Référence
Plan de l'etude: Cohort (retrospective)
Financement: Government
Cadre: Outpatient (primary care)
Sommaire
This study focused on the primary care use of 3 screening tests defined as low value by the Choosing Wisely campaign: (1) chest radiographs for patients at low risk for cardiovascular disease and pulmonary disease, (2) EKGs for patients at low risk of cardiovascular disease, and (3) Pap tests for women younger than 21 years or older than 69 years. This population-based study evaluated all administrative claims over 5 years in Ontario, Canada. For each low-value test the authors identified patients in each cohort who were at low risk. Within these groups they identified patients who had low-value screening at the time of (or shortly after) an annual health examination. Then they charted specialist visits, diagnostic tests, and procedures related to those tests over the subsequent 90 days (up to 180 days following a Pap test or computed tomography (CT) scanning to account for wait times in the province). The authors matched these patients with similar patients who didn't receive testing. Though rates were still fairly low, the results are not surprising: chest x-rays were associated with an almost 3-fold likelihood of a pulmonology visit, an 8-fold increase in bronchoscopy, and a 3-fold increase in CT scans. EKG-receiving patients were 3 times as likely to be sent to a cardiologist, approximately 4 times more likely to receive additional cardiac testing, and almost 3 times more likely to undergo cardiac catheterization. Pap tests triggered slightly more gynecology visits, approximately a 16-fold increase in follow-up Pap tests, and a 5-fold increase in colposcopy rates. There is no way to know if these increased visits were worthwhile. -
Reviewer
Allen F. Shaughnessy, PharmD, MMedEd
Professor of Family Medicine
Tufts University
Boston, MA
Commentaires
reassurance
These tests are used to keep people happy. There are other ways.
Awareness about it is key-amongst Physicians and educating p
I am an advocate for this, have attended conferences validating this but still experiencing, difficulty practicing this in real time with very insistent patients and those who have been doing this for years with their previous GPs.
Good to have have this presentation
No
Need more information
It might be that the study was poorly designed or that some information wasn't included in this review. My concern is that often patients would come for an "annual" and have new symptoms which trigger a test +/- a referral.
What did you expect ?
Of course screening results in further testing. That is the purpose of it. The question to be answered is, is it justified.
unnecessary investigations
but what is missing is the outcome of these extra " unnecessary " investigations so this study only highlights only half of the issue raised.
Chest xrays , ECG etc.
It would have been much more useful if the end results and relevance of the further triggered investigations were evaluated.
This has left us somewhat up in the air. The end result must, surely be, "Did the initial investigation trigger further investigation that resulted in significant health improvement for the patient?
We were not told that.
Subject
Comment from survey