According to the study, the field testers agreed with the following practices:
- Family medicine—limit early imaging for low back pain, avoid routinely prescribing antibiotics for sinus infections, avoid ordering electrocardiograms or other cardiac screening in low-risk patients with no symptoms, reserve Pap tests for patients age 21 years or older who have not had hysterectomy for benign disease, and reserve dual-energy X-ray absorptiometry osteoporosis scans for women ages 65 years and older and men 70 years and older or who have risk factors
- Internal medicine—limit early imaging for low back pain, do not order blood panels or urinalysis for screening in healthy adults with no symptoms, avoid ordering ECGs or other cardiac screening in low-risk patients with no symptoms, limit initial statin prescriptions to generic medications, and reserve DEXA osteoporosis scans for women ages 65 years and older and men 70 years and older or who have risk factors
- Pediatrics—avoid prescribing antibiotics for sore throats unless tests for streptococcus are positive, limit diagnostic imaging for minor head injuries without loss of consciousness or other risk factors, do not refer middle-ear infections (otitis media with effusion) to specialists too early, tell parents to avoid giving children over-the-counter cough and cold medicines, and ensure that inhaled corticosteroids are used properly by patients with asthma
The NPA plans to distribute the Top 5 lists for each specialty to its members in those fields, create training videos to help doctors communicate the value of these behaviors, and create videos that explain to patients why the steps on the Top 5 lists should be taken, and reach out to consumer groups and patient-safety groups for their endorsements.
Although the study focuses on primary care physicians, Smith says he hopes that specialists will take up the challenge and identify cost-savings and inefficiencies in their own realms. "The specialists have just as much responsibility. But this is where we wanted to start. It seems like a good beginning and hopefully it will lead to other specialists doing the same," he says.
John Commins is a senior editor with HealthLeaders Media.