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'Top 5' list helps primary care doctors make wiser clinical decisions
Date:5/23/2011

PHILADELPHIA -- A physician panel in the primary care specialty of internal medicine has identified common clinical activities where changes in practice could lead to higher quality care and better use of finite clinical resources.

The study identifying the Top 5 list of internal medicine activities appears online in the Archives of Internal Medicine.

"Our aim was to come up with a list of best practices via consensus from actual practitioners, said Jeffrey R. Jaeger, MD, FACP, associate professor of Internal Medicine in the Perelman School of Medicine at the University of Pennsylvania, who led the internal medicine panel which produced the list of the top five recommendations in that specialty. "These practices deliver superior patient care while at the same time save resources by eliminating unnecessary testing and procedures."

"Top 5" List for Internal Medicine

1. Don't Overimage: Don't do imaging for low back pain within the first six weeks unless red flags are present.
Low back pain is the fifth most common reason for all physician visits. Imaging of the lumbar spine before six weeks does not improve outcomes but does increase costs. Red flags include severe or progressive neurological deficits or when serious underlying conditions such as osteomyelitis are suspected.

2. Don't Overscreen: Don't obtain blood chemistry panels (e.g. CMP, SMA-7, and BMP) or urinalyses for screening in asymptomatic, healthy adults.
Only lipid screening yielded significant numbers of positive results among asymptomatic patients, physicians should screen for type 2 diabetes mellitus in asymptomatic adults with hypertension

3. Don't Over-order Cardiac Tests: Don't order annual electrocardiograms or any other cardiac screening for asymptomatic, low-risk patients.
There is little evidence that detection of coronary artery stenosis in asymptomatic patients at low risk for coronary heart disea
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Contact: Marc Kaplan
Marc.Kaplan@uphs.upenn.edu
215-349-5660
University of Pennsylvania School of Medicine
Source:Eurekalert

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