Weekly Must Reads in Patient Safety and Health Care (November 20, 2015) – Over-Diagnosis and Over-Treatment

A recent review published in JAMA Internal Medicine raises the question whether there is over-diagnosis and over-treatment:

There is widespread agreement that more is not always better in health care. Doing more can harm patients, generate excess costs, and defy patient preferences. All are major threats to the delivery of high-quality health care. Reflecting this notion, the Institute of Medicine (IOM) National Roundtable on Health Care Quality coined the term overuse in 1998, adapting the definition of an inappropriate service developed for the RAND Appropriateness Method in the 1980s. Overuse was defined as “a health care service [that] is provided under circumstances in which its potential for harm exceeds the possible benefit.

An example of over-treatment:

Postoperative Opioid Use Continues Past the Postoperative Period: Opioid drugs are often used for post-operative pain control. The review referenced a study that found 3% of patients continue to take opioid prescriptions beyond 90 days after the procedure. The review opined: “Clinicians should diligently reassess patients receiving postoperative opioids to ensure that these medications are used safely and appropriately because opioid overuse is associated with obvious psychological and physical harm. Given the millions of patients undergoing surgery each year, it is essential that postoperative opioid use does not become a gateway to long-term opioid use.”


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