Physician group lists top 5 don'ts for primary care

You've heard it before -- you can improve your patients' health outcomes and waste fewer Medicare dollars by avoiding useless procedures and tests. Now a physician group has published a top-five list of don'ts for primary care doctors to avoid.

Highlights include cautions against imaging scans for back pain within the first six weeks unless "red flags" are present and support for prescribing generic statins for lipid-lowering drug therapy. These are two of the five items listed by the non-profit National Physicians Alliance (NPA), which actually released three separate "top five" lists for internists, family practitioners and pediatricians.

Here's the top five for internists, plus the NPA's rationale for each item:

1. Don’t do imaging for low back pain within the first six weeks unless red flags* are present.
     •  Imaging of the lumbar spine before six weeks does not improve outcomes but does increase costs
     •  Low back pain is the fifth most common reason for all physician visits
     •  Red flags include, but are not limited to, severe or progressive neurological deficits or when serious underlying conditions such as osteomyelitis are suspected
2. Don’t obtain blood chemistry panels (e.g. CMP, SMA-7, BMP) or urinalyses for screening in asymptomatic, healthy adults.
     •  Only lipid screening yielded significant numbers of positive results among asymptomatic patients
     •  Screen for type 2 diabetes mellitus in asymptomatic adults with hypertension
3. Don’t order annual ECGs or any other cardiac screening for asymptomatic, low-risk patients.
     •  Little evidence that detection of coronary artery stenosis in asymptomatic patients at low risk for coronary heart disease improves
   health outcomes
     •  False-positive tests are likely to lead to harm through unnecessary invasive procedures, over-treatment, and misdiagnosis
     •  Potential harms of this routine annual screening exceed the potential benefit
4.  Use only generic statins when initiating lipid-lowering drug therapy.
     •  All statins are effective in decreasing mortality, heart attacks, and strokes when dose is titrated to effect appropriate
   LDL-cholesterol reduction
     •  Switch to more expensive brand-name statins (atrovastatin [Lipitor] or rosuvastatin [Crestor]) only if generic statins cause
   clinical reactions or do not achieve LDL-cholesterol goals
5. Don’t use DEXA screening for osteoporosis in women under age 65 or men under 70 with no risk factors.*
     •  Not cost effective in younger, low-risk patients, but cost effective in older patients
     •  Risk factors include, but are not limited to: fractures after age 50, prolonged exposure to corticosteroids, diet deficient in calcium or vitamin D, cigarette smoking, alcoholism, thin and small build.

You can check out all three lists as downloadable PDFs by visiting the NPA website.