Researchers from Mount Sinai School of Medicine have found that the overuse of health care procedures, diagnostic tests and medications has been widespread in the United States for at least 30 years. Such unnecessary health care services contribute to high medical costs, and could be harmful to patients. The study was published today in JAMA’s Archives of Internal Medicine.
The Mount Sinai researchers studied 172 articles published in MEDLINE from 1978 through 2009, which described the overuse of procedures, diagnostic tests, and medications in the United States. The most commonly studied services were antibiotics for upper respiratory infections, coronary angiography, carotid endarterectomy and coronary revascularization (including coronary artery bypass grafting).
“Overuse” of healthcare services was defined as services for which the benefits are outweighed by the negative effects, including unnecessarily contributing to high medical costs. Though rates of overuse varied widely, there was evidence of overuse of all services studied. In the articles studied, rates of overuse of antibiotics for upper respiratory infections ranged from 2 percent to 89 percent; overuse of coronary angiography ranged from 4 percent to 21.8 percent; carotid enderterectomy overuse ranged from 1 percent to 33 percent; and the over use of coronary revascularization ranged from 1.4 percent to 15 percent.
Overuse of screening tests was also common, and was highest for pap smears for cervical cancer (58 percent) and colon cancer screening after a previously negative test (61 percent).
“In spite of a paucity of information about the overuse of many services, our findings suggest that overuse is common,” said the study’s co-author, Deborah R. Korenstein, MD, Associate Professor of General Internal Medicine at Mount Sinai School of Medicine. “The high rate of overuse of many preventive and screening services is particularly notable; since screening is performed in most patients its overuse would result in a large amount of unnecessary care and could be both costly and harmful.” “More research into the appropriateness of screening tests would help physicians to target limited resources,” said co-author Salomeh Keyhani, MD, MPH, Assistant Professor of Medicine at University of California, San Francisco. “Given the importance placed on delivering high quality efficient care, there seems to be a disconnect between this often stated health care policy goal and the amount of research investment in this area, there is an underuse of overuse research.”