The American Board of Internal Medicine Foundation’s Choosing Wisely initiative recently prompted several scientific specialty societies to create “Top 5” lists of medical services that provide no overall benefit to patients in most situations. In a recent review of the lists, researchers determined that costs were the largest contributing factor for the societies’ selections.
The campaign comprises 25 societies, including: the American Academy of Allergy, Asthma and Immunology, the American Academy of Hospice and Palliative Medicine, the American Urological Association, the American Geriatrics Society, and the American Academy of Family Physicians, according to the research paper.
Steven D. Pearson, MD, MSc, and Catherine Gliwa, BA, of the department of bioethics at the National Institutes of Health, analyzed the rationales and found that of 135 services, 49 (36% were for patient diagnosis, prognosis, or monitoring; 46 (34%) for patient treatment; and 40 (30%) for population screening. Moreover, initial evidence categorization was identical for 128 (95%) services, the researchers wrote.
Steven D. Pearson
The inclusion of 102 (76%) services were justified by claims that adequate evidence demonstrated no additional benefit with greater risk, higher cost, or both, compared with other options, according to Pearson and Gliwa.
“The second most common rationale, given for 18 services (13%), was that there was insufficient evidence to evaluate comparative benefit for use of the service beyond the evidentiary boundaries of established indications, frequency, intensity, or dosage,” they said.
Data indicated that, overall, 66 (49%) of all 135 rationales mentioned greater risks for patients as a consideration for choosing the service, 33 (24%) mentioned greater costs, 21 (16%) cited greater risk and cost, and 57 (42%) did not mention either of the two.
Of the societies included in the campaign program, 60% included at least one service justified due to greater costs for service.
“Specialty societies can enhance trust in the Choosing Wisely campaign by defining more clearly the types of potentially wasteful medical care they seek to eliminate, and by providing a clear evidentiary justification for the selection of each service,” the researchers concluded.
Disclosure: See the study for a full list of relevant financial disclosures.