What could primary-care physicians do differently to benefit patients’ health and cut risks, harms and costs? The National Physicians Alliance, a 22,000-member group of doctors that advocates for affordable, universal health care, came out with its own list — lists, actually, since there’s one each for family medicine, internal medicine and pediatrics. The group’s recommendations are published in the Archives of Internal Medicine . The suggestions reflect the consensus of the physician working groups that developed them. Field testers completed online surveys to rate each suggestion on the impact it would have on quality of care and cost, the strength of the supporting evidence and the ease of implementing the activity. Without further ado, here are the lists (stripped of the more detailed explanations published in the journal). Tell us what you think: Top Five List, Family Medicine Don’t do imaging for low-back pain in the first six weeks unless certain red flags are present. Don’t routinely prescribe antibiotics for acute mild to moderate sinus inflammation unless certain symptoms last at least seven days or improve, then worsen. Don’t order annual ECGs or other cardiac screening for low-risk patients with no symptoms. Don’t perform Pap smears on patients younger than 21 years of age or in women who had a hysterectomy for benign disease. Don’t use DEXA screening for osteoporosis in women under age 65 years or men under 70 with no risk factors. Top Five List, Internal Medicine The list included the same recommendations on low-back pain, cardiac screening and DEXA screening, as well as: Don’t obtain blood chemistry panels or urinalyses for screening in healthy adults with no symptoms. Use only generic statins when initiating lipid-lowering drug therapy. Top Five List, Pediatrics Don’t prescribe antibiotics for a sore throat unless the patient tests positive for strep. Don’t obtain diagnostic images for minor head injuries without loss of consciousness or other risk factors. Don’t refer patients to a specialist for fluid behind the eardrum in the middle ear early on unless there are other red flags (such as learning problems or structural problems). Advise patients not to use cough and cold medicines. Use inhaled corticosteroids to control asthma appropriately. Image: iStockphoto
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Reader Consult: Are These The Top 5 Ways To Improve Primary Care?