The French Society of Internal Medicine's Top-5 List of Recommendations: a National Web-Based Survey.
Choosing Wisely
inappropriate prescribing
internal medicine
overmedicalization
Journal
Journal of general internal medicine
ISSN: 1525-1497
Titre abrégé: J Gen Intern Med
Pays: United States
ID NLM: 8605834
Informations de publication
Date de publication:
08 2019
08 2019
Historique:
received:
07
06
2018
accepted:
27
03
2019
revised:
17
12
2018
pubmed:
14
6
2019
medline:
5
11
2020
entrez:
14
6
2019
Statut:
ppublish
Résumé
The international project "Choosing Wisely" aims to target unnecessary and potentially harmful examinations and treatments. To define the French Internal Medicine Top-5 list. Based on a review of existing Top-5 lists and personal experience, a working group of the French National Society of Internal Medicine selected 27 diagnostic and therapeutic procedures. They were submitted through a national web-based survey to French internists who rated from 1 to 5 the perceived frequency, uselessness, and risk of each procedure. A composite score was calculated as the unweighted addition of the three scores. Four hundred thirty internists answered the web-based survey (14% of all French internists including residents). All the French regions and status of the profession were represented. For the 27 submitted procedures, the mean score (± SD) was 3.25 (± 0.48) for frequency, 3.10 (± 0.43) for uselessness, and 2.63 (± 0.84) for risk. The Top-5 list obtained with the composite score was as follows: 1. Do not prescribe long-term treatment with proton pump inhibitors without regular reevaluation of the indication 2. Do not administer preventive treatments (e.g., for dyslipidemia, hypertension…) in elderly people with dementia when potential risks outweigh the benefits 3. Do not administer hypnotic medications as first-line treatment for insomnia 4. Do not treat with an anticoagulant for more than 3 months a patient with a first venous thromboembolism occurring in the setting of a major transient risk factor 5. Do not screen for Lyme disease without an exposure history or related clinical examination findings We found that the composite score was strongly correlated to the risk score (r This Top-5 list provides an opportunity to discuss appropriate use of health care practices in internal medicine.
Sections du résumé
BACKGROUND
The international project "Choosing Wisely" aims to target unnecessary and potentially harmful examinations and treatments.
OBJECTIVE
To define the French Internal Medicine Top-5 list.
DESIGN
Based on a review of existing Top-5 lists and personal experience, a working group of the French National Society of Internal Medicine selected 27 diagnostic and therapeutic procedures. They were submitted through a national web-based survey to French internists who rated from 1 to 5 the perceived frequency, uselessness, and risk of each procedure. A composite score was calculated as the unweighted addition of the three scores.
PARTICIPANTS
Four hundred thirty internists answered the web-based survey (14% of all French internists including residents). All the French regions and status of the profession were represented.
KEY RESULTS
For the 27 submitted procedures, the mean score (± SD) was 3.25 (± 0.48) for frequency, 3.10 (± 0.43) for uselessness, and 2.63 (± 0.84) for risk. The Top-5 list obtained with the composite score was as follows: 1. Do not prescribe long-term treatment with proton pump inhibitors without regular reevaluation of the indication 2. Do not administer preventive treatments (e.g., for dyslipidemia, hypertension…) in elderly people with dementia when potential risks outweigh the benefits 3. Do not administer hypnotic medications as first-line treatment for insomnia 4. Do not treat with an anticoagulant for more than 3 months a patient with a first venous thromboembolism occurring in the setting of a major transient risk factor 5. Do not screen for Lyme disease without an exposure history or related clinical examination findings We found that the composite score was strongly correlated to the risk score (r
CONCLUSIONS
This Top-5 list provides an opportunity to discuss appropriate use of health care practices in internal medicine.
Identifiants
pubmed: 31190258
doi: 10.1007/s11606-019-05050-2
pii: 10.1007/s11606-019-05050-2
pmc: PMC6667601
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1475-1485Références
Acad Med. 2017 May;92(5):576
pubmed: 28441197
BMJ. 2011 May 24;342:d3036
pubmed: 21610040
MMWR Morb Mortal Wkly Rep. 2017 Jun 16;66(23):607-609
pubmed: 28617768
Implement Sci. 2014 Jan 08;9:1
pubmed: 24398253
Am J Hematol. 2012 May;87 Suppl 1:S63-7
pubmed: 22367958
CMAJ. 2015 Aug 11;187(11):E341-E342
pubmed: 26170270
JAMA. 2016 Nov 15;316(19):1997-2007
pubmed: 27838723
Intern Emerg Med. 2016 Dec;11(8):1125-1130
pubmed: 27804077
Eur J Clin Microbiol Infect Dis. 2014 Oct;33(10):1803-8
pubmed: 24838649
Can Fam Physician. 2017 May;63(5):354-364
pubmed: 28500192
BMJ. 2005 Nov 19;331(7526):1169
pubmed: 16284208
Clin Infect Dis. 2006 Nov 1;43(9):1089-134
pubmed: 17029130
Internist (Berl). 2016 Jun;57(6):521-6
pubmed: 27251671
Curr Psychiatry Rep. 2016 Oct;18(10):89
pubmed: 27549604
J Rheumatol. 2015 Apr;42(4):682-9
pubmed: 25641889
JAMA Intern Med. 2014 Apr;174(4):588-95
pubmed: 24567036
JAMA Intern Med. 2015 Apr;175(4):642-4
pubmed: 25706806
JAMA. 2012 Oct 24;308(16):1635-6
pubmed: 23093160
Dig Dis Sci. 2011 Apr;56(4):931-50
pubmed: 21365243
Cochrane Database Syst Rev. 2017 Mar 16;3:CD011969
pubmed: 28301676
Arch Intern Med. 2006 Mar 27;166(6):605-9
pubmed: 16567597
J Gen Intern Med. 2014 Mar;29(3):432-3
pubmed: 24197627
Clin Infect Dis. 2015 Nov 1;61(9):1374-80
pubmed: 26195017
J Am Geriatr Soc. 2011 Oct;59(10):1883-90
pubmed: 22091502
Int J Public Health. 2018 Jul;63(6):765-773
pubmed: 29691594
Ann Intern Med. 2016 Jul 19;165(2):125-33
pubmed: 27136449
Am J Med. 2017 Aug;130(8):927-936.e9
pubmed: 28454668
JAMA. 2018 May 15;319(19):1975-1976
pubmed: 29710232
JAMA. 1994 Feb 9;271(6):460-3
pubmed: 8080498
Z Evid Fortbild Qual Gesundhwes. 2017 Dec;129:31-36
pubmed: 29153354
BMJ. 2015 May 12;350:h2308
pubmed: 25985331
Drugs Aging. 2017 Oct;34(10):767-776
pubmed: 28853000
J Am Board Fam Med. 2016 Jul-Aug;29(4):512-5
pubmed: 27390384
Chest. 2012 Feb;141(2 Suppl):e419S-e496S
pubmed: 22315268
J Sleep Res. 2017 Dec;26(6):675-700
pubmed: 28875581
Ann Intern Med. 2002 Feb 5;136(3):243-6
pubmed: 11827500
Am J Prev Med. 2016 Jul;51(1):141-9
pubmed: 27155735
J Hosp Med. 2008 Nov-Dec;3(6):473-82
pubmed: 19084897
Arch Intern Med. 2010 May 10;170(9):749-50
pubmed: 20458080
Clin Microbiol Infect. 2015 Dec;21(12):1098-103
pubmed: 26321669
Cochrane Database Syst Rev. 2014 Aug 05;(8):CD001367
pubmed: 25092359
J Hosp Med. 2013 Sep;8(9):486-92
pubmed: 23956231
Gastroenterology. 2017 Mar;152(4):706-715
pubmed: 28257716
J Gen Intern Med. 2018 Jun;33(6):804-806
pubmed: 29497987
Clin Microbiol Infect. 2018 Feb;24(2):118-124
pubmed: 28887186