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Recommendations for Minimizing Five Overused Preventive Services

The American College of Preventive Medicine (ACPM) has identified five overused preventive services that contribute to wasteful healthcare spending and can lead to unnecessary complications for healthy patients.

To minimize the improper use of these practices and tests, the ACPM Choosing Wisely® Task Force has published the following plain language recommendations to inform physicians, allied health professionals, and patients of their potential dangers. These strategies advise:

  • Don't take a multivitamin, vitamin E or beta carotene to prevent cardiovascular disease or cancer.
  • Don't routinely perform prostate-specific antigen–based screening for prostate cancer.
  • Don't use whole-body scans for early tumor detection in asymptomatic patients.
  • Don't use expensive medications when an equally effective and lower-cost medication is available.
  • Don't perform screening for cervical cancer in low-risk women aged 65 years or older and in women who have had a total hysterectomy for benign disease.

"While preventive services are extremely important to promote to patients and are often underutilized, there is overuse of some preventive services that can lead to patient harm, unnecessary follow up testing, and/or waste," said Dr. Cat Livingston, Oregon Health & Science University.

Not all preventive services are created equal, and some, if misused or overused, can cause more harm than good for a patient by falsely indicating the presence of a condition and exposing them to subsequent costly care protocols which carry their own health risks. Nationally, the overuse of preventive services can put a strain on providers’ time and drain financial resources that could otherwise be allocated toward strategies which provide the maximum benefit to the patient.

The task force's rationale behind each recommendation, described in brief below, illustrates how treatments designed to promote health or catch conditions early can actually cost patients more money and lead to worse health outcomes in the long run.

These five recommendations, recently published in the American Journal of Preventive Medicine, were developed by ACPM’s Choosing Wisely® Task Force as part of the national Choosing Wisely® campaign focused on quality improvement and the identification of wasteful or unnecessary medical tests, procedures and treatments. Led by the American Board of Internal Medicine Foundation, the campaign has inspired 70 partner organizations to provide recommendations which inform wise decision making by medical professionals and patients.

Many of the Choosing Wisely® recommendations have been developed into patient factsheets by Consumer Reports, including two derived from the ACPM’s recommendations on Dietary Supplements to Prevent Heart Disease or Cancer and Whole-Body Scans to Screen for Cancer.

The American College of Preventive Medicine (ACPM) Prevention Practice Committee is an active participant in the Choosing Wisely® project. The committee created the ACPM Choosing Wisely Task Force to lead the development of ACPM's recommendations with the intention of facilitating wise decisions about the appropriate use of preventive care. After utilizing an iterative process that involved reviewing evidence-based literature, the ACPM Choosing Wisely Task Force developed five recommendations targeted toward overused services within the field of preventive medicine. These recommendations were published by Elsevier Inc. on behalf of American Journal of Preventive Medicine 2016;51(1):141–149.

CONTACTS

Catherine J. Livingston, MD, MPH
Oregon Health & Science University
livingsc@ohsu.edu

Paul Bonta, MA 
Associate Executive Director of Policy, Advocacy & External Affairs, ACPM
202 466 2044 x 110
pbonta@acpm.org

RELATED RESOURCES
REFERENCE

Choosing Wisely® in Preventive Medicine: The American College of Preventive Medicine's Top 5 List of Recommendations. Catherine J. Livingston, MD, MPH; Randall J. Freeman, MD, MPH, MBA, MTM&H; Amir Mohammad, MD, MPH; Victoria C. Costales, MD, MPH; Tisha M. Titus, MD, MPH; Bart J. Harvey, MD, MSc, PhD, MEd; Kevin M. Sherin, MD, MPH, MBA; and the Choosing Wiselys Task Force. Am J Prev Med 2016;51(1):141–149. Published by Elsevier Inc. on behalf of American Journal of Preventive Medicine. Link.

SUMMARIES

The ACPM Choosing Wisely® Task Force has published plain language recommendations for medical professionals and patients regarding five of the most overused preventive services contributing to wasteful healthcare spending and unnecessary complications for healthy patients. // http://www.acpm.org/page/pschoosingwisely 

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