The Australian healthcare system has been reviewing the investigations and treatments that place the biggest burden on Medicare. Many tests and drugs are being prescribed with a lack of evidence or against the best evidence, which can increase Medicare costs. Patients are often undergoing tests which are not appropriate, time consuming or when other interventions would be cheaper or better. News.com.au reports on the 29th of April, 2015.
“DOCTORS have identified 25 wasteful tests and treatments they say shouldn’t be given because they are costing Medicare billions of dollars each year — without improving patient outcomes.
Five specialty groups will on Wednesday unveil the “Choosing Wisely” list which tells doctors not to prescribe long term medicines like esomeprazole and omeprazole to beat heartburn and gastric reflux.”
Though the cost of some items might seem small, it can blow out the budget. When you consider almost 7 million scripts were written last year for some of these medicines, it starts to add up:
“These medicines cost taxpayers $450 million last financial year with more than 6.9 million scripts written for esomeprazole.”
Pressure is being put on doctors to focus on wellness strategies, prevention and lifestyle changes rather than what experts perceive as caving to the wants— rather than needs— of patients.
“Too often patients put doctors under pressure to order a test or write a prescription when watching and waiting or changing lifestyle might be better options, she said.”
The long term side effects of some commonly prescribed medicines can cause more harm than good, and the article draws specific attention to this, particularly for reflux and heart disease. This would eventually create a bigger burden on the healthcare system. Therefore by shifting the focus to primary healthcare, there should be an overall reduced demand for chronic disease management, diagnostic imaging and tertiary intervention. After all, they do say prevention is the best cure.
The Choosing Wisely campaign is led by doctors and is separate to but complements the government’s attempts to crack down on Medicare waste in the budget.
The Australasian College of Emergency Medicine wants doctors to ensure very old and infirm patients understand the goals of medical care before expensive interventions are made and consider palliative care instead.
The Royal College of Pathologists Australasia says doctors should not order urine test for the elderly in absence symptoms, not order prostate screening in men with less than seven years to live or cholesterol tests for those with limited life expectancy.
The Australian Society for Clinical Immunology and allergy warns about unscientific allergy testing and treatment which can be unreliable and usually comes at a cost to the patients.
This list includes some of the potentially wasteful tests and treatments
Royal Australian College General Practitioners
1. Don’t use esomeprazole and omeprazole long term to beat heartburn and gastric reflux.
2. Don’t prescribe medicines for high blood pressure or cholesterol in patients who are at low risk of a heart attack
3. Don’t ask Type 2 diabetes patients to self-monitor blood glucose if they use an oral medication only
4. Don’t screen asymptomatic patients for heart disease
5. Don’t prescribe benzodiazepines to patients with a history of substance abuse, alcohol abuse or those on psychoactive drugs.
Australasian College Emergency Medicine
1. Avoid CAT scans of kidneys in otherwise healthy patients with a known history kidney stones
2. Avoid blood clot studies in Emergency unless the patient has a history of warfarin, or heparin use or liver disease.
3. Don’t do blood tests in patients in emergency unless they are systemically septic.
4. for patients approaching end of life ensure patients and families have understanding goals of care consider palliative care.
5. Don’t request scans of cervical spine in trauma patients unless a clinical decision tool indicates the test
6. Don’t request CAT scans of the head in patients with a head injury unless a clinical decision tool calls for one.
Royal Australian New Zealand College Radiologists
1. Don’t request scans for acute ankle trauma unless indicated by the Ottawa Ankle Rules
2. Don’t request ultrasound for deep vein thrombosis is risk assessment core is less than 2
3. Don’t request testing for blocked artery in lung unless indicated by Wells Score
4. Don’t order a scan for non- specific acute back pain
5. Don’t request imaging cervical spine in trauma patient unless indicated by clinical decision tool
6. Don’t request CAT scan for patient with a head injury unless a clinical decision tool recommends it
Australasian Society Clinical Immunology
1. Don’t use antihistamines to treat anaphylaxis, use adrenaline
2. Don’t use unorthodox methods to test and treat allergies
3. Don’t use allergen immunotherapy for routine treatment of food allergies
4. Don’t use allergy test results on their own in the absence clinical symptoms results are not of significance
5. Don’t delay introducing solid food to infants, 4-6 months is the best time to introduce solids.
Medical technology continues to evolve and improve. Doctors are committed to the ongoing testing of medical investigations and treatment options. Through clinical experience and research, doctors will be able to recommend the most accurate tests and effective treatments for patient care.