List for Better Primary Care

Cutting back on unnecessary antibiotics, delaying wasteful imaging for lower back pain and foregoing annual ECG screenings for healthy, low-risk patients are among the actions that could help streamline primary care, experts say.

Perhaps taking a page from David Letterman’s Top 10 list, the authors of a new report came up with a “Top 5” list of action items for each of the primary care disciplines — family medicine, internal medicine and pediatrics — to help save money and conserve health resources.

Many physicians are already behind the suggestions, according to the report, which appears online May 23 in the Archives of Internal Medicine.

“I have seen many instances where I thought clinicians were not making the right and wisest decisions in ways that were not good for patients’ health and not good for prudent use of finite resources,” said Dr. Stephen Smith, one of the report’s authors and professor emeritus of family medicine at the Warren Alpert School of Medicine at Brown University in Providence, RI.

Smith is also a member of the National Physicians’ Alliance (NPA), a group of 22,000 doctors promoting affordable and quality healthcare, which put together the lists.

None of the suggestions are particularly new, having been validated by scores of studies, yet few clinicians seem to be implementing them, Smith said.

Here are the Top Five recommendations for each discipline:

For family medicine:

  • Avoid imaging for lower back pain for six weeks unless red flags are present.
  • Cut back on prescribing antibiotics for sinus infections, since most are viral.
  • Avoid cardiac screening in patients who are low risk and have no symptoms.
  • Do not do Pap tests for cervical cancer in women under 21 or those who have had a hysterectomy for benign disease.
  • Confine bone density scans known as dual-energy X-ray absorptiometry (DEXA) for osteoporosis to women aged 65 and over and for men 70 and older who also have risk factors, such as those who have already had fractures.