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The next steps…. Tips. Doing More by doing less. Where did these tips come from?. Developed by the National Physicians Alliance, with a grant from the ABIM Evidence-based, quality-improving, resource-sparing activities that can easily be incorporated into practice
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Tips Doing Morebydoing less
Where did these tips come from? • Developed by the National Physicians Alliance, with a grant from the ABIM • Evidence-based, quality-improving, resource-sparing activities that can easily be incorporated into practice • An initial list generated by a working group that will be distributed to all NPA members
Note on the NPA • Founded in 2005 • 22,000 members belonging to all kinds of specialties • Stated goal: ensure affordable high-quality health care for all
Tip One Don’t order imaging tests for low back pain within the first six weeks of symptoms unless red flags are present.
Don’t prescribe antibiotics for mild to moderate sinusitis unless symptoms last for more than seven days or worsen. Tip Two
Don’t order ECGs (or any cardiac screening tests) for asymptomatic, low risk patients. Tip Three
Tip Four Don’t do paps on women who are younger than 21 or women who have had a hysterectomy for benign disease
Don’t screen women under 65 or men under 70 for osteoporosis with DEXAs unless they have risk factors for osteoporosis. Tip Five
Some thoughts about bisphosphonates… • The FDA is about to begin a review of the safety of these medications. • Side effects of prolonged use (more than five years) may include atypical femoral fractures, osteonecrosis of the jaw, esophageal ulcers, bone fragility, and prolonged fracture healing time. • The benefits after five years of use are unclear while the risks probably increase. • Optimal age of initiation of this therapy is probably at age 65 or older because this is when the risk of fracture increases.
