The "Top 5" Lists in Primary Care

The National Physicians Alliance has developed a list of the top five activities in family medicine, internal medicine and pediatrics where quality of care can be improved, according to a report published in the Archive of Internal Medicine. These lists are made up of evidence-based, quality-improving, resource-sparing activities that should be implemented in primary care practices across the U.S.

The NPA was awarded a grant by the American Board of Internal Medicine Foundation to develop the lists. Three groups were made up of physicians in each of the three primary care specialties.

The physicians then rated activities where quality of care could be improved for their specialty based on five parameters: how frequently they engage in the activity; the potential impact of the activity on quality of care; the impact on cost of care; evidence supporting the activity; and the ease of implementing the activity.

For the most part, the three groups came up with different activities, although the family medicine and internal medicine groups selected three of the same activities. According to the report, “this commonality across specialties reinforced the importance and relevance of addressing overuse of these activities.”

The next step is for the lists to be distributed among NPA physicians and set up help so physicians can implement the recommended activities. What the report also discovered was that misunderstanding and miscommunication between patients and their physicians often led to unnecessary and harmful tests and treatments. By clearing up understanding with their patients, physicians can improve satisfaction and reduce unnecessary tests and treatments.

Below are the lists of activities where quality of care can be improved and costs reduced.

Internal Medicine

1. Don’t do Imaging for low back pain within the first six weeks unless red flags are present.

2. Don’t obtain blood chemistry panels or urinalyses for screening in asymptomatic, healthy adults.

3. Don’t order annual ECGs or any other cardiac screening for asymptomatic, low-risk patients.

4. Use only generic statins when initiating lipid-lowering drug therapy.

5. Don’t use DEXA screening for osteoporosis in women under the age of 65 or men under 78 with no risk factors.

Family Medicine

1. Don’t do Imaging for low back pain within the first six weeks unless red flags are present.

2. Don’t routinely prescribe antibiotics for acute mild to moderate sinusitis unless symptoms last for seven or more days, or if symptoms worsen after initial clinical improvement.

3. Don’t order annual ECGs or any other cardiac screening for asymptomatic, low-risk patients.

4. Don’t perform Pap tests on patients younger than 21 years or in women status post hysterectomy for benign disease.

5. Don’t use DEXA screening for osteoporosis in women under the age of 65 or men under 78 with no risk factors.

Pediatrics

1. Don’t prescribe antibiotics for pharyngitis unless the patient tests positive for streptococcus.

2. Don’t obtain diagnostic images for minor head injuries without loss of consciousness or other risk factors.

3. Don’t refer OME early in the course of the problem.

4. Advise patients not to use cough and cold medications.

5. Use inhaled corticosteroids to control asthma appropriately.