American Academy of Family Physicians Identifies List of Commonly Used Tests and Treatments to Question
Choosing Wisely Campaign aims to encourage physician and patient conversations on potentially unnecessary care in family medicine
FOR IMMEDIATE RELEASE
Thursday, Feb. 21, 2013
LEAWOOD, Kan. – Today the American Academy of Family Physicians released its second list of specific tests or procedures that are commonly ordered, but not always necessary, in family medicine as part of the Choosing Wisely® campaign(www.choosingwisely.org), an initiative of the American Board of Internal Medicine Foundation. The list identifies five targeted, evidence-based recommendations that can support conversations between patients and physicians about what care is really necessary.
The AAFP’s list identified the following five recommendations:
- Don’t schedule elective, non-medically indicated inductions of labor or cesarean deliveries before 39 weeks, 0 days gestational age. Delivery prior to 39 weeks, 0 days, has been shown to be associated with an increased risk of learning disabilities and a potential increase in morbidity and mortality. There are clear medical indications for delivery prior to 39 weeks and 0 days based on maternal and/or fetal conditions. A mature fetal lung test, in the absence of appropriate clinical criteria, is not an indication for delivery.
- Avoid elective, non-medically indicated inductions of labor between 39 weeks, 0 days and 41 weeks, 0 days unless the cervix is deemed favorable. Ideally, labor should start on its own initiative whenever possible. Higher cesarean delivery rates result from inductions of labor when the cervix is unfavorable. Health care clinicians should discuss the risks and benefits with their patients before considering inductions of labor without medical indications.
- Don’t screen for carotid artery stenosis (CAS) in asymptomatic adult patients. There is good evidence that for adult patients with no symptoms of carotid artery stenosis, the harms of screening outweigh the benefits. Screening could lead to non-indicated surgeries that result in serious harms, including death, stroke and heart attack.
- Don’t screen women older than 65 years of age for cervical cancer who have had adequate prior screening and are not otherwise at high risk for cervical cancer. There is adequate evidence that screening women older than 65 years of age for cervical cancer who have had adequate prior screening and are not otherwise at high risk provides little to no benefit.
- Don’t screen women younger than 30 years of age for cervical cancer with human papillomavirus testing, alone or in combination with cytology. There is adequate evidence that the harms of HPV testing, alone or in combination with cytology, in women younger than 30 years of age are moderate. The harms include more frequent testing and invasive diagnostic procedures such as colposcopy and cervical biopsy. Abnormal screening test results are also associated with psychological harms, anxiety and distress.
“The American Academy of Family Physicians is committed to the Choosing Wisely campaign and its mission of sharing evidence-based clinical information about tests and procedures to help family physicians and their patients make informed decisions. So much so that the AAFP has extended its involvement, developing a second list of five screenings and treatments that are frequently overused or misused,” said Glen R. Stream, MD, MBI, board chair of the AAFP. “It has been estimated that nearly one-third of health care delivered in the United States is unnecessary. Tests and procedures that lack evidence of their effectiveness put our patients at risk and drive up the cost of care.”
All the lists released today as part of the Choosing Wisely campaign were developed by individual specialty societies after months of careful consideration and review. Using the most current evidence about management and treatment options within their specialty, the societies believe the recommendations can make a significant impact on patient care, safety and quality.
The AAFP created its list of clinical recommendations for the second phase of the Choosing Wisely campaign with the goal of identifying screenings and procedures in family medicine which evidence suggest might be overused leading to unnecessary risks, harms and costs. For each item, evidence was reviewed from appropriate sources such as the Cochrane Collaboration, and the Agency for Healthcare Research and Quality. The AAFP’s Commission on Health of the Public and Science reviewed and approved the recommendations.
In the case of the first two items on its list — concerning elective, non-medically indicated inductions of labor or cesarean deliveries — the AAFP collaborated with the American College of Obstetricians and Gynecologists in developing the final language.
Sixteen other organizations are releasing lists along with the AAFP today, representing more than 350,000 physicians, nurses, pathologists, radiologists and other health care professionals. They are:
- American Academy of Hospice and Palliative Medicine
- American Academy of Neurology
- American Academy of Ophthalmology
- American Academy of Otolaryngology—Head and Neck Surgery
- American Academy of Pediatrics
- American College of Obstetricians and Gynecologists
- American College of Rheumatology
- American Geriatrics Society
- American Society for Clinical Pathology
- American Society of Echocardiography
- American Urological Association
- Society of Cardiovascular Computed Tomography
- Society of Hospital Medicine
- Society of Nuclear Medicine and Molecular Imaging
- Society of Thoracic Surgeons
- Society for Vascular Medicine
“The AAFP has a long history of leadership in helping physicians be careful stewards of health care resources. Our ongoing involvement in the Choosing Wisely campaign underscores family physicians’ commitment to ensuring high-quality, cost-effective care to our patients,” Stream said.
In April 2012, nine medical specialty societies each released lists as part of the Choosing Wisely campaign. To date, more than 130 tests and procedures to question have been released as part of the campaign, and the specialty societies are now undertaking considerable efforts to share the recommendations with their collective membership of more than 725,000 physicians.
The campaign is also reaching millions of consumers nationwide through a stable of consumer partners, led by Consumer Reports — the world’s largest independent product-testing organization — which has worked with the ABIM Foundation to distribute patient-friendly resources for consumers and physicians to engage in these important conversations. Choosing Wisely consumer partners include:
- Alliance Health Networks
- The Leapfrog Group
- Midwest Business Group on Health
- Minnesota Health Action Group
- National Business Coalition on Health
- National Business Group on Health
- National Center for Farmworker Health
- National Hospice and Palliative Care Organization
- National Partnership for Women & Families
- Pacific Business Group on Health
- Union Plus
In addition, the campaign announced specialty societies who will release new lists later in 2013. The AAFP will release a third list of five recommendations, and will be joined by:
- American Academy of Dermatology
- American Academy of Orthopaedic Surgeons
- American College of Rheumatology*
- American College of Surgeons
- American College of Chest Physicians
- American Headache Society
- AMDA—Dedicated to Long Term Care Medicine
- American Society of Clinical Oncology*
- American Society for Hematology
- American Society for Radiation Oncology
- American Thoracic Society
- Heart Rhythm Society
- North American Spine Society
- Society of General Internal Medicine
*Releasing a second list
To learn more about Choosing Wisely and to view the complete lists and additional detail about the recommendations and evidence supporting them, visit www.ChoosingWisely.org(www.ChoosingWisely.org).
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Founded in 1947, the AAFP represents 136,700 physicians and medical students nationwide. It is the largest medical society devoted solely to primary care. Family physicians conduct approximately one in five office visits -- that’s 192 million visits annually or 48 percent more than the next most visited medical specialty. Today, family physicians provide more care for America’s underserved and rural populations than any other medical specialty. Family medicine’s cornerstone is an ongoing, personal patient-physician relationship focused on integrated care. To learn more about the specialty of family medicine, the AAFP's positions on issues and clinical care, and for downloadable multi-media highlighting family medicine, visit www.aafp.org/media. For information about health care, health conditions and wellness, please visit the AAFP’s award-winning consumer website, www.familydoctor.org(familydoctor.org).