How would you improve primary care?

THREE lists of the “top 5” clinical activities that improve patient care while reducing costs in primary care have been compiled by an American doctors’ association.

The National Physicians Alliance (NPA) created the lists of “evidence-based, quality-improving, resource-sparing activities” for family medicine, paediatrics and internal medicine.

The NPA’s suggestions were scrutinised by 83 primary care physicians initially and then by another 172 doctors who rated each activity according to its potential impact on the quality and cost of care, its evidence base and its ease of implementation.

The lists, published in the Archives of Internal Medicine, focus on a less-is-more approach to primary care. (1)

All three lists contain more “don’ts” than “dos”, with an emphasis on cutting out imaging and screening tests in low-risk populations and limiting antibiotic prescribing.

GPs are advised to target the use of lumbar spine imaging for low back pain, Pap smears and antibiotics for acute sinusitis to populations that will receive the most benefit.

The authors write that patient cooperation is required to implement the recommendations, and that they will seek endorsements from consumer groups.

“Having such endorsements will help dispel the misconception that these clinical recommendations represent rationing and support the idea that often less is truly more,” they write.

Top five clinical activities in family medicine:

1. Don’t do imaging for low back pain within the first 6 weeks unless red flags (including severe or progressive neurological deficits) are present

2. Don’t routinely prescribe antibiotics for acute mild to moderate sinusitis unless symptoms (which must include purulent nasal secretions AND maxillary pain or facial or dental tenderness to percussion) last for 7 or more days OR symptoms worsen after initial clinical improvement

3. Don’t order annual ECGs or any other cardiac screening for asymptomatic, low-risk patients

4. Don’ perform Pap tests on patients younger than 21 years or in women status post-hysterectomy for benign disease

5. Don’t use DEXA (dual energy X-ray absorptiometry) screening for osteoporosis in women under age 65 years or men under 70 years with no risk factors (including fractures after age 50)

- Sophie McNamara

1. Arch Intern Med 2011: (Published online, May 23)

Posted 30 May 2011

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