Researchers devised a new way to ensure that older adults aren’t being overtreated or tested needlessly. Their efforts resulted in lower unnecessary screenings for cancer, urinary tract infections and diabetes. The trial was published on Feb. 6 in Annals of Internal Medicine.
Investigators from Northwestern Medicine modified electronic health records. The team created alerts that specified when a test a doctor was about to order could result in harm to the patient, or if the test did not come under guideline recommendations. The team delivered alerts to 371 clinicians in 60 Northwestern Medicine clinics over the course of 18 months.
In particular, the researchers tested to find if the alerts would thwart unnecessary prostate-specific antigen (PSA) testing in men ages 76 years and older without previous prostate cancer, urine testing for nonspecific reasons in women over the age of 65, and the prescription of hypoglycemic agents in people over the age of 75 who had diabetes and and hemoglobin A1c (HbA1c) levels that were under 7%.
Unnecessary testing fell by 8.7% in the PSA group and 5.5% in the urine testing group. There was a 1.4% reduction in overtreating blood sugar as a result of the alerts.
“To our knowledge, this is the first study to significantly reduce all of the unnecessary testing or treatments studied using point-of-care alerts,” Stephen Persell, MD, a professor of medicine at Northwestern University Feinberg School of Medicine and a Northwestern Medicine physician, and lead author, said in a statement. “We believe that incorporating elements like a focus on potential harms, sharing social norms and promoting a sense of social accountability and reputational concerns led to the effectiveness of these messages.”
Persell said that other research that was aimed at lowering the use of unnecessary testing was only minimally successful at changing the behavior of clinicians. Meanwhile, there are screening practices that healthcare professionals have adopted that aren’t backed by solid evidence, he noted.
“If a man is not going to live another 10 or 15 years due to his age, you won’t save his life from prostate cancer by screening him, but you will subject him to the potential harms of treatment,” said Persell. The treatment may lead to surgery or radiation treatment that can cause urinary incontinence or urinary symptoms, impair sexual function or cause rectal bleeding.
Similar harms can come from testing women for urinary tract infections, as can treating older adults who are diabetic yet are prescribed sugar-lowering drugs that could lead to dangerous outcomes.
