Of all the treatments that patients use, the ones that benefit patients the least include unneeded antibiotics and dietary supplements, according to a recent survey of U.S. doctors. In the survey, researchers at the American College of Physicians (ACP) gathered responses from more than 1,000 ACP member physicians. They identified 15 therapeutic interventions that respondents felt did not provide high value to patients. It is the second of two surveys on high-value care, which is defined as providing treatments to patients that have benefits that outweigh their potential harms and avoid unnecessary costs. In their report, the researchers noted that an expensive treatment could be considered a high-value one if its potential benefits outweigh its costs and harms, and that an inexpensive treatment might be considered low value if its benefits do not outweigh even its low costs. "The bottom line: the health care costs are rising," and they're increasing at an unsustainable rate, Dr. Amir Qaseem, the lead author of the paper and chair of ACP’s High Value Care Task Force, told Live Science. "Because of that, we wanted to highlight this whole issue of high-value care." In the survey, researchers sent out an email survey to ACP member physicians and asked them to identify two treatments that other doctors frequently used in clinics but were unlikely to provide high value to patients. From these responses, researchers identified 15 treatments that at least 1 percent of physicians named. The interventions that were most frequently cited by the physicians who were surveyed as providing low value to patients included antibiotics, with 27.3 percent of doctors naming them as a low-value treatment; aggressive nonpalliative treatment – such as feeding tubes or intubation – in patients with limited life expectancy (8.6 percent); drugs such as opioids and narcotics for chronic pain management (7.3 percent); and dietary supplements (4.9 percent). The survey is not the first research to look into low-value care. A 2016 study published in the journal JAMA found that at least 30 percent of antibiotics prescribed by physicians are unnecessary, and a 2016 study published in the International Journal for Quality in Health Care found that between 33 and 38 percent of patients receive nonbeneficial treatments as part of their end-of-life care. Doctors might prescribe such treatments, even if their peers see them as low value, because of a lack of guidelines or a lack of knowledge about the treatment, Qaseem told Live Science. But another common reason doctors offer low-value treatments is patient expectations, he said. For example, if a patient takes a day off from work and shows up at the physician's office with an upper respiratory tract infection, that patient may desire antibiotics, and even pressure the doctor to prescribe them. Although the doctor may suspect the infection is a viral one, and that the antibiotics will do nothing toward treating it, he or she may also fear malpractice, or have inadequate time to spend with the patient, making it easier to write a prescription than to sit down and talk, Qaseem said. The most important takeaway from the findings is that patients should talk to their doctors, and ask questions, Qaseem said. In addition, physicians should think about why they are ordering a treatment and if it will improve the patient's clinical outcome, he said. "The bottom line is, am I ordering this treatment primarily because the patient might want it, or to reassure the patient?" he said. The study has a few limitations. It relies on self-reported data that may not reflect actual overused interventions. In addition, the list of interventions in the survey was not inclusive. According to the study, the authors hope that the work will help health care move toward a more value-driven system. Source
