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Medical overuse of therapies and diagnostics in rheumatology

  • Perspectives in Rheumatology
  • Published:
Clinical Rheumatology Aims and scope Submit manuscript

An Editorial to this article was published on 04 April 2021

Abstract

Medical overuse leads to a burden on healthcare costs and potentially is harmful to patients. We wanted to address medical overuse in musculoskeletal disease and rheumatology. We performed a systemic literature review from PubMed and Embase to study medical overuse. On the initial screen, 1499 studies were identified, 839 of them were related to medical overuse. Out of these, 52 were related to overuse in musculoskeletal diseases. Finally, 20 articles were chosen for this systemic review that reported overuse in rheumatology. The article identifies issues with overtesting, including the use of dual-energy X-ray absorptiometry to screen for osteoporosis in women younger than 65 years old and the use of magnetic resonance imaging to evaluate for osteoarthritis. Studies related to overtreatment reported over-prescription of vitamin D supplements resulting in vitamin D toxicity and increased risk of inappropriate prescriptions in patients with osteoarthritis and rheumatoid arthritis. Overtreating osteoporosis was reported after industry-sponsored education. Articles describing methods to reduce overuse included a study showing the reduction of unnecessary dual-energy X-ray absorptiometry scans after the introduction of the Choosing Wisely Campaign. Our findings suggest that there is some evidence that overtesting and overtreatment may be present in the field of rheumatology. This review aims to highlight this and help rheumatologists to be aware of overuse practices and provide appropriate evidence-based healthcare.

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References

  1. Chassin MR, Galvin RW (1998) Quality and the NR on HC. The urgent need to improve health care quality Institute of Medicine National Roundtable on Health Care Quality. JAMA. 280(11):1000–1005. https://doi.org/10.1001/jama.280.11.1000

    Article  CAS  PubMed  Google Scholar 

  2. Koch C, Roberts K, Petruccelli C, Morgan DJ (2018) The frequency of unnecessary testing in hospitalized patients. Am J Med 131(5):500–503. https://doi.org/10.1016/j.amjmed.2017.11.025

    Article  PubMed  Google Scholar 

  3. Nguyen LT, Sullivan CT, Makam AN (2015) The diagnostic cascade of incidental findings: a teachable moment. JAMA Intern Med 175(7):1089–1090

    Article  Google Scholar 

  4. Morgan DJ, Dhruva SS, Coon ER, Wright SM, Korenstein D (2019) 2019 Update on medical overuse. JAMA Intern Med 179:1568. https://doi.org/10.1001/jamainternmed.2019.3842

    Article  PubMed  Google Scholar 

  5. Morgan DJ, Dhruva SS, Coon ER, Wright SM, Korenstein D (2018) 2018 Update on medical overuse. JAMA Intern Med 179(2):240–246. https://doi.org/10.1001/jamainternmed.2018.5748

    Article  Google Scholar 

  6. Morgan DJ, Dhruva SS, Coon ER, Wright SM, Korenstein D (2017) 2017 Update on medical overuse. JAMA Intern Med 178(1):110–115. https://doi.org/10.1001/jamainternmed.2017.4361

    Article  Google Scholar 

  7. Morgan DJ, Dhruva SS, Wright SM, Korenstein D (2016) 2016 Update on medical overuse. JAMA Intern Med 176(1):1687–1692. https://doi.org/10.1001/jamainternmed.2016.5381

    Article  PubMed  PubMed Central  Google Scholar 

  8. Morgan DJ, Dhruva SS, Wright SM, Korenstein D (2015) Update on medical practices that should be questioned. JAMA Intern Med 175(12):1960–1964. https://doi.org/10.1001/jamainternmed.2015.5614

    Article  PubMed  PubMed Central  Google Scholar 

  9. Morgan DJ, Dhruva SS, Wright SM (2015) Update on medical overuse. JAMA Intern Med 175(1):120–124. https://doi.org/10.1001/jamainternmed.2014.5444

    Article  PubMed  Google Scholar 

  10. Coon ER, Quinonez RA, Morgan DJ, Dhruva SS, Ho T, Money N, Schroeder AR (2019) 2018 Update on pediatric medical overuse. JAMA Pediatr 173(4):379–384. https://doi.org/10.1001/jamapediatrics.2018.5550

    Article  PubMed  Google Scholar 

  11. Coon ER, Young PC, Quinonez RA, Morgan DJ, Dhruva SS, Schroeder AR (2018) 2017 Update on pediatric medical overuse. JAMA Pediatr 172(5):482–486. https://doi.org/10.1001/jamapediatrics.2017.5752

    Article  PubMed  Google Scholar 

  12. Isaac T, Rosenthal MB, Colla CH et al (2018) Measuring overuse with electronic health records data. Am J Manag Care 24(1):19–25

    PubMed  Google Scholar 

  13. Sherman SL, Gulbrandsen TR, Lewis HA et al (2018) Overuse of magnetic resonance imaging in the diagnosis and treatment of moderate to severe osteoarthritis. Iowa Orthop J 8(2):33–37

    Google Scholar 

  14. Kupfer S, Winklhofer S, Becker AS, Distler O, Chung CB, Alkadhi H, Finkenstaedt T (2018) Gouty arthritis: Can we avoid unnecessary dual-energy CT examinations using prior radiographs? PLoS One 13(7):1–11. https://doi.org/10.1371/journal.pone.0200473

    Article  CAS  Google Scholar 

  15. Bianco A, Zucco R, Lotito F, Pavia M (2018) To what extent do hospitalised patients receive appropriate CT and MRI scans? Results of a cross-sectional study in Southern Italy. BMJ Open 8(2):e018125. Published 2018 Feb 12. https://doi.org/10.1136/bmjopen-2017-018125

    Article  PubMed  PubMed Central  Google Scholar 

  16. Mintzes B, Swandari S, Fabbri A, Grundy Q, Moynihan R, Bero L (2018) Does industry-sponsored education foster overdiagnosis and overtreatment of depression, osteoporosis and over-active bladder syndrome? An Australian cohort study. BMJ Open 8(2):1–11. https://doi.org/10.1136/bmjopen-2017-019027

    Article  Google Scholar 

  17. Taylor PN, Davies JS (2018) A review of the growing risk of vitamin D toxicity from inappropriate practice. Br J Clin Pharmacol 84(6):1121–1127. https://doi.org/10.1111/bcp.13573

    Article  PubMed  PubMed Central  Google Scholar 

  18. Alhawassi TM, Alatawi W, Alwhaibi M (2019) Prevalence of potentially inappropriate medications use among older adults and risk factors using the 2015 American Geriatrics Society Beers criteria. BMC Geriatr 19(1):154. Published 2019 May 29. https://doi.org/10.1186/s12877-019-1168-1

    Article  PubMed  PubMed Central  Google Scholar 

  19. Laville SM, Metzger M, Stengel B, Jacquelinet C, Combe C, Fouque D, Laville M, Frimat L, Ayav C, Speyer E, Robinson BM, Massy ZA, Liabeuf S (2018) Evaluation of the adequacy of drug prescriptions in patients with chronic kidney disease: results from the CKD-REIN cohort. Br J Clin Pharmacol 84:2811–2823. https://doi.org/10.1111/bcp.13738

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Sakr S, Hallit S, Haddad M, Khabbaz LR (2018) Assessment of potentially inappropriate medications in elderly according to Beers 2015 and STOPP criteria and their association with treatment satisfaction. Arch Gerontol Geriatr 78:132–138. https://doi.org/10.1016/j.archger.2018.06.009

    Article  PubMed  Google Scholar 

  21. Akkawi M, Mohamed M (2018) Influence of hospitalization on potentially inappropriate prescribing among elderly patients in a Malaysian community. Trop J Pharm Res 17(1):151–160

    Article  CAS  Google Scholar 

  22. Almeida TA, Reis EA, Pinto IVL, Ceccato MGB, Silveira MR, Lima MG, Reis AMM (2019) Factors associated with the use of potentially inappropriate medications by older adults in primary health care: an analysis comparing AGS Beers, EU(7)-PIM List , and Brazilian Consensus PIM criteria. Res Soc Adm Pharm 15(4):370–377. https://doi.org/10.1016/j.sapharm.2018.06.002

    Article  Google Scholar 

  23. Soriano R, Andrés M, Oliveira E et al (2016) Serum uric acid lowering treatment appears unnecessary during hemodialysis. Arthritis Rheum 68(10):205

    Google Scholar 

  24. Thomas M, Meinzer U (2018) A large proportion of patients with non-septic acute arthritis receive unnecessary invasive treatments. Pediatr Rheumatol 16(2):388

    Google Scholar 

  25. Varinen A, Kosunen E, Koskela T (2018) Thyroid hormone treatment and hormone levels among fibromyalgia patients in a Finnish health center -are there indications of overuse? MJ Evid Based Med 23(2):43

    Google Scholar 

  26. Martel-Pelletier J, Maheu E, Pelletier JP, Alekseeva L, Mkinsi O, Branco J, Monod P, Planta F, Reginster JY, Rannou F (2019) A new decision tree for diagnosis of osteoarthritis in primary care: International Consensus of Experts. Aging Clin Exp Res 31(1):19–30. https://doi.org/10.1007/s40520-018-1077-8

    Article  PubMed  Google Scholar 

  27. Petrilli CM, Henderson J, Keedy JM, et al. Reducing unnecessary vitamin D screening in an academic health system: what works and when. 2018. 131(12): 1444-1448. doi: https://doi.org/10.1016/j.amjmed.2018.06.025.

  28. Emprechtinger R, Fischer S, Holzer LA et al (2018) Methods to detect inappropriate use of MRI and CT for musculoskeletal conditions: a scoping review. Z Evid Fortbild Qual Gesundhwes 137-138:20–26. https://doi.org/10.1016/j.zefq.2018.09.002

    Article  PubMed  Google Scholar 

  29. Kim SJ, Han KT, Kang HG, Park EC (2018) Toward safer prescribing: evaluation of a prospective drug utilization review system on inappropriate prescriptions, prescribing patterns, and adverse drug events and related health expenditure in South Korea. Public Health 163:128–136. https://doi.org/10.1016/j.puhe.2018.06.009

    Article  CAS  PubMed  Google Scholar 

  30. Pugel S, Stallworth JL, Pugh LB, Terrell C, Bailey Z, Gramling T, Ward H (2018) Choosing Wisely in Georgia: a quality improvement initiative in 25 adult ambulatory medicine offices. Jt Comm J Qual Patient Saf 44(12):699–707. https://doi.org/10.1016/j.jcjq.2018.05.010

    Article  PubMed  Google Scholar 

  31. Hamlin S, Mansoor T, Lynch N, Moneley D (2018) The application of the rACR scoring system in the diagnosis of giant cell arteritis. Surg Curr Res 8:40

    Google Scholar 

  32. Levinson W, Kallewaard M, Bhatia RS (2015) On behalf of the Choosing Wisely International Working Group, et al ‘Choosing Wisely’: a growing international campaign. BMJ Qual Saf 24:167–174

    Article  Google Scholar 

  33. Lambden JP, Chamberlin P, Kozlov E, Lief L, Berlin DA, Pelissier LA, Yushuvayev E, Pan CX, Prigerson HG (2019) Association of Perceived Futile or Potentially Inappropriate Care With Burnout and Thoughts of Quitting Among Health-Care Providers. Am J Hosp Palliat Care 36(3):200–206. https://doi.org/10.1177/1049909118792517

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Maryland School of Medicine, 10 S Pine Street, MSTF room 8.34, Baltimore, MD, 21201, USA

    Muznay N. Khawaja, Bernadette C. Siaton & Marc C. Hochberg

  2. Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA

    Eaman Alhassan

  3. Department of Rheumatology, University of Arizona School of Medicine, Tucson, AZ, USA

    Jawad Bilal

  4. Department of Rheumatology, Albert Einstein Medical Center, Philadelphia, PA, USA

    Shraddha Jatwani

  5. Department of Rheumatology, Hospital for Special Surgery, New York, NY, USA

    Bella Mehta

  6. Department of Rheumatology, Loyola University School of Medicine, Chicago, IL, USA

    Varun Bhalla

  7. Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA

    Daniel J. Morgan & Marc C. Hochberg

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  1. Muznay N. Khawaja
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  2. Eaman Alhassan
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Correspondence to Muznay N. Khawaja.

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Khawaja, M.N., Alhassan, E., Bilal, J. et al. Medical overuse of therapies and diagnostics in rheumatology. Clin Rheumatol 40, 2087–2094 (2021). https://doi.org/10.1007/s10067-021-05638-2

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  • DOI: https://doi.org/10.1007/s10067-021-05638-2

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