Preventing overdiagnosis: How to stop harming the healthy

Bond University, Robina, Queensland, Australia.
BMJ (online) (Impact Factor: 17.45). 05/2012; 344(may28 4):e3502. DOI: 10.1136/bmj.e3502
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Available from: David Henry, Aug 16, 2014
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    • "For example, in the USA, between 1995 and 2005 the frequency of computed tomography (CT) has doubled and for magnetic resonance imaging (MRI) it has more than tripled [2]. The increase of diagnostic tests can lead to a false-positive diagnosis, 'pseudo' disease, or adverse effects, resulting in an unnecessary chain of events [3] [4] [5] [6]. Imaging procedures may also lead to incidental findings, which can be found in both symptomatic and asymptomatic individuals [7] [8] indicating that diagnostic imaging findings may not always be responsible for the complaints experienced by the patient. "
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    ABSTRACT: The increasing use of diagnostic imaging has led to high expenditures, unnecessary invasive procedures and/or false-positive diagnoses, without certainty that the patients actually benefit from these imaging procedures. This review explores whether diagnostic imaging leads to better patient-reported outcomes in individuals with musculoskeletal disorders. Databases were searched from inception to September 2013, together with scrutiny of selected bibliographies. Trials were eligible when: 1) a diagnostic imaging procedure was compared with any control group not getting or not receiving the results of imaging; 2) the population included individuals suffering from musculoskeletal disorders, and 3) if patient-reported outcomes were available. Primary outcome measures were pain and function. Secondary outcome measures were satisfaction and quality of life. Subgroup analysis was done for different musculoskeletal complaints and high technological medical imaging (MRI/CT). Eleven trials were eligible. The effects of diagnostic imaging were only evaluated in patients with low back pain (n=7) and knee complaints (n=4). Overall, there was a moderate level of evidence for no benefit of diagnostic imaging on all outcomes compared with controls. A significant but clinically irrelevant effect was found in favor of no (routine) imaging in low back pain patients in terms of pain severity at short [SMD 0.17 (0.04-0.31)] and long-term follow-up [SMD 0.13 (0.02-0.24)], and for overall improvement [RR 1.15 (1.03-1.28)]. Subgroup analysis did not significantly change these results. These results strengthen the available evidence that routine referral to diagnostic imaging by general practitioners for patients with knee and low back pain yields little to no benefit. Copyright © 2015 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
    European Journal of Internal Medicine 07/2015; 26(8). DOI:10.1016/j.ejim.2015.06.018 · 2.89 Impact Factor
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    • "" rispondono di avere una qualche disabilità. Se la prospettiva (Moynihan, 2012) è quella che ciascun adulto possa avere almeno una malattia che necessiti di monitoraggio, accertamenti e cure, le conseguenze sull'autodefinizione del proprio stato di salute possono essere pesanti. Gli indicatori della speranza di vita in buona salute non sono abbastanza autonomi da questi condizionamenti. "
    • "In acknowledging the challenges in applying the Rule of Halves to symptomatic osteoarthritis, the importance of individual patient values and needs should perhaps be emphasised. Improving patient care is not simply a case of ‘more medicine’27,28. "
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    ABSTRACT: Background Symptomatic osteoarthritis poses a major challenge to primary health care but no studies have related accessing primary care (‘detection’), receiving recommended treatments (‘treatment’), and achieving adequate control (‘control’). Objective To provide estimates of detection, treatment, and control within a single population adapting the approach used to determine a Rule of Halves for other long-term conditions. Setting General population. Participants 400 adults aged 50+ years with prevalent symptomatic knee osteoarthritis. Design Prospective cohort with baseline questionnaire, clinical assessment, and plain radiographs, and questionnaire follow-up at 18 and 36 months and linkage to primary care medical records. Outcome measures ‘Detection’ was defined as at least one musculoskeletal knee-related GP consultation between baseline and 36 months. ‘Treatment’ was self-reported use of at least one recommended treatment or physiotherapy/hospital specialist referral for their knee problem at all three measurement points. Pain was ‘controlled’ if characteristic pain intensity <5 out of 10 on at least two occasions. Results In 221 cases (55.3%; 95%CI: 50.4, 60.1) there was evidence that the current problem had been detected in general practice. Of those detected, 164 (74.2% (68.4, 80.0)) were receiving one or more of the recommended treatments at all three measurement points. Of those detected and treated, 45 (27.4% (20.5, 34.3)) had symptoms under control on at least two occasions. Using narrower definitions resulted in substantially lower estimates. Conclusion Osteoarthritis care does not conform to a Rule of Halves. Symptom control is low among those accessing healthcare and receiving treatment.
    Osteoarthritis and Cartilage 04/2014; 22(4). DOI:10.1016/j.joca.2014.02.006 · 4.17 Impact Factor
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