Results of interventions to reduce overuse of medical care not sustained after discontinuation

Results of interventions to reduce overuse of medical care not sustained after discontinuation

Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-24-02738

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A pragmatic, cluster randomized trial evaluating the long-term effectiveness of behavioral interventions to reduce over testing and overtreatment in older adults found that the effects of the interventions did not last in the year after the intervention ended. The findings are published in Annals of Internal Medicine.

Researchers from Northwestern University and colleagues studied data from 60 primary care practices in Chicago, Illinois to determine the sustained effectiveness of a behavioral intervention to reduce over testing and overtreatment of older adults in three areas identified by the American Geriatrics Society “Choosing Wisely” campaign—prostate-specific antigen screening (PSA), testing for urinary tract infections (UTIs) in women without specific reasons, and overtreatment of diabetes with drugs causing hypoglycemia. The intervention was clinical decision support (CDS) delivered to 371 clinicians through the electronic health record and was designed to increase attention to the harms of overuse of care. The primary outcomes measured were changes in annual rates of PSA screening in men aged 76 years or older without history of prostate cancer; urine testing in women aged 65 years or older obtained for nonspecific reasons; and treating patients with diabetes aged 75 years or older to a hemoglobin A1c level of less than 7.0% using insulin, a sulfonylurea, or meglitinide. By the end of the intervention period, the intervention group lowered the rates of overtreatment and over testing in all three primary outcomes. The researchers then evaluated the persistence of the intervention effectiveness during a 12-month postintervention period in which the CDS was no longer delivered to clinicians and found that the results were not sustained. The findings suggest that to maintain benefits CDS interventions should be left in place or provided on a less frequent basis to reduce alert fatigue.

Media contacts: For an embargoed PDF, please contact Angela Collom at [email protected]. To speak with corresponding author Lucia C. Petito, PhD, please email [email protected].