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Patients at Hospital-Based Primary Practices May Get Unnecessary Tests

“An estimated 10 to 30 percent of health care spending in the United States stems from services that provide low-value care,” said first author John Mafi, an assistant professor of medicine in the Division of General Internal Medicine and Health Services Research at the David Geffen School of Medicine at UCLA. “Reducing the use of such services can not only help curb health care costs–and redirect such resources in more meaningful way–but also protect patients from the potentially harmful effects associated with such services.”

Common examples of low-value care include prescribing antibiotics for a patient with the common cold or other viral upper respiratory infection not affected by antibiotics, or sending a patient with uncomplicated back pain or headache for an MRI or a CT scan.

In their analysis, the team compared patient records obtained from two national databases, comprising more than 31,000 patient visits over a 17-year period during which patients sought treatment in hospital-based primary care clinics or community-based clinics for upper respiratory infections, back pain and headaches.

In order to better identify patients for whom the services were likely of low value, the researchers excluded those with more complex symptoms suggestive of a more serious disorder as well as people with underlying disorders and chronic conditions.

Antibiotic prescription rates were similar in community- and hospital-based clinics.

However, hospital-treated patients were referred more often for MRIs and CT scans (8 percent, compared with 6 percent) than community-treated patients, more often for X-ray testing (13 percent, compared with 9 percent) and more often for an evaluation by a specialist (19 percent, compared with 7.6 percent).

Additionally, the patients most likely to receive unnecessary tests and services were those visiting hospital-based primary care clinics but seeing someone other than their usual primary care physician. The finding, the researchers say, highlights the importance of continuity of care and suggests that when patients bounce from physician to physician they may be more likely to be over-tested or over-treated.

“Not seeing your regular primary care physician–what we call discontinuity of care–might be a weak spot where low value care can creep in,” Landon said. “The more we know about what situations are most likely to lead to patients’ receiving low-value care, the more we can do to prevent it.”

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Co-authors on the study include Christina Wee, HMS associate professor of medicine at Beth Israel Deaconess Medical Center, and Roger Davis, associate professor of medicine (biostatistics) at Beth Israel Deaconess and associate professor of biostatistics at the Harvard T.H. Chan School of Public Health.

This research was supported with funding from the National Institutes of Health (Midcareer Mentorship Award K24DK087932 and Harvard Catalyst National Institutes of Health Award UL1 TR001102).