Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Maryland School of Medicine, 10 S Pine Street, MSTF room 8.34, Baltimore, MD, 21201, USA.
Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
Clin Rheumatol. 2021 May;40(5):2087-2094. doi: 10.1007/s10067-021-05638-2. Epub 2021 Feb 10.
Medical overuse leads to a burden on healthcare costs and potentially is harmful to patients. We wanted to address medical overuse in musculoskeletal disease and rheumatology. We performed a systemic literature review from PubMed and Embase to study medical overuse. On the initial screen, 1499 studies were identified, 839 of them were related to medical overuse. Out of these, 52 were related to overuse in musculoskeletal diseases. Finally, 20 articles were chosen for this systemic review that reported overuse in rheumatology. The article identifies issues with overtesting, including the use of dual-energy X-ray absorptiometry to screen for osteoporosis in women younger than 65 years old and the use of magnetic resonance imaging to evaluate for osteoarthritis. Studies related to overtreatment reported over-prescription of vitamin D supplements resulting in vitamin D toxicity and increased risk of inappropriate prescriptions in patients with osteoarthritis and rheumatoid arthritis. Overtreating osteoporosis was reported after industry-sponsored education. Articles describing methods to reduce overuse included a study showing the reduction of unnecessary dual-energy X-ray absorptiometry scans after the introduction of the Choosing Wisely Campaign. Our findings suggest that there is some evidence that overtesting and overtreatment may be present in the field of rheumatology. This review aims to highlight this and help rheumatologists to be aware of overuse practices and provide appropriate evidence-based healthcare.
医疗过度使用导致医疗保健费用负担加重，并且可能对患者造成伤害。我们希望解决肌肉骨骼疾病和风湿病中的医疗过度使用问题。我们从 PubMed 和 Embase 进行了系统文献回顾，以研究医疗过度使用。在初步筛选中，确定了 1499 项研究，其中 839 项与医疗过度使用有关。在这些研究中，有 52 项与肌肉骨骼疾病的过度使用有关。最后，选择了 20 篇报道风湿病中过度使用的系统性综述文章。这篇文章确定了过度检测的问题，包括使用双能 X 线吸收法对 65 岁以下女性进行骨质疏松症筛查，以及使用磁共振成像评估骨关节炎。与过度治疗相关的研究报告了维生素 D 补充剂的过度处方，导致维生素 D 毒性和骨关节炎和类风湿关节炎患者处方不当的风险增加。在行业赞助的教育之后，报告了过度治疗骨质疏松症的情况。描述减少过度使用方法的文章包括一项研究，该研究表明，在倡导明智选择运动后，可减少不必要的双能 X 线吸收法扫描。我们的研究结果表明，有一些证据表明，在风湿病领域可能存在过度检测和过度治疗的情况。本综述旨在强调这一点，并帮助风湿病医生意识到过度使用的做法，并提供基于证据的适当医疗保健。
