Researchers have 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 results were published 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 a 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 out whether the alerts would thwart unnecessary prostate-specific antigen testing in men aged 76 or more years without previous prostate cancer, urine testing for nonspecific reasons in women aged more than 65, and the prescription of hypoglycemic agents in people aged more than 75 who had diabetes and hemoglobin A1c 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, a Northwestern Medicine physician and the study’s 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, healthcare professionals have adopted some screeening practices 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,” Persell said. 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 have diabetes yet are prescribed blood glucose-lowering drugs that could lead to dangerous outcomes.
