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MONDAY, Feb. 12, 2024 (HealthDay Information) — The physician tapped at his laptop, ordering a routine prostate examination for an 80-year-old man, when a dramatic yellow alert popped up on the affected person’s digital well being document.
“You might be ordering a take a look at that no guideline recommends,” it warned. “Screening with PSA can result in harms from diagnostic and remedy procedures. In the event you proceed with out a justification, the pointless take a look at will likely be famous on the well being document.”
The message was a part of a technique Northwestern Medication investigators had been testing to see if it might immediate docs to cease ordering pointless screenings for older adults.
And it labored, in accordance with a brand new report within the Annals of Inside Medication.
Researchers noticed a big 9% lower in pointless PSA checks after 18 months of delivering the alerts, in addition to an almost 6% lower in urine checks for urinary tract an infection in girls.
“To our information, that is the primary research to considerably scale back the entire pointless testing or therapies studied utilizing point-of-care alerts,” mentioned lead researcher Dr. Stephen Persell, a professor at Northwestern College Feinberg College of Medication in Chicago.
This research concerned 370 clinicians at 60 Northwestern Medication clinics. Half acquired the alerts, and half didn’t.
Prior research have tried to cut back pointless screenings utilizing messages delivered to docs by digital well being information, however Persell and his group assume they’ve stumble on the best mixture of phrases to affect docs.
“We imagine that incorporating parts like a deal with potential harms, sharing social norms and selling a way of social accountability and reputational considerations led to the effectiveness of those messages,” Persell mentioned in a college information launch.
“If messages clinicians discover compelling might be delivered by digital well being information on the time clinicians place their orders, this could possibly be a simple means to enhance care and could possibly be utilized throughout massive well being programs simply,” he added.
Screening males older than 75 for prostate most cancers can result in remedy that gained’t lengthen their lives, prior analysis has discovered. They’re higher off merely dwelling with an indolent most cancers of which they’re unaware. (An indolent most cancers is one that might not present signs in a affected person’s lifetime and wouldn’t contribute to demise.)
The identical is true of ladies 65 and older examined for urinary tract infections with none signs, and sufferers 75 and older with excessive blood sugar, researchers mentioned.
“These are screening practices folks have adopted with out good proof,” Persell mentioned. “If a person is just not going to reside one other 10 or 15 years because of his age, you gained’t save his life from prostate most cancers by screening him, however you’ll topic him to the potential harms of remedy.”
The affected person might wind up present process surgical procedure or radiation remedy that may trigger urinary incontinence or urinary signs, impair sexual operate or trigger rectal bleeding, he famous.
“What’s proper for a 68-year-old man won’t be proper for one who’s 75 or 85 years previous,” Persell mentioned.
The identical is true for urinary tract infections in girls 65 and older, Persell mentioned.
“These asymptomatic urinary tract infections are frequent in older girls, however there isn’t a proof which you could enhance a lady’s well being with antibiotics,” Persell mentioned.
Nonetheless, antibiotics could cause allergic reactions, diarrhea and antibiotic resistance, which might make bacterial infections tougher to deal with sooner or later, Persell mentioned.
Treating blood sugar to very low ranges in adults utilizing medicine like insulin or sulfonylureas can be harmful, because it will increase their danger for hypoglycemia.
Sadly, the messages didn’t work as properly when it got here to reining in pointless checks for blood sugar ranges, both for docs or sufferers.
“We’ve got taught sufferers to attempt to manage their blood sugar, even when it will get to some extent when it’s safer to have barely much less managed blood sugar,” Persell mentioned. “It’s onerous to persuade sufferers and docs to alter their objectives.”
Researchers subsequent hope to attempt these messages to stem different kinds of overtreatment, together with opioid and sleeping tablet prescriptions and doubtlessly harmful drug mixtures.
Extra data
The College of Colorado has extra about overtreatment.
SOURCE: Northwestern College, information launch, Feb. 6, 2024
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