Mudro odlučivanje
Datum objave: Ponedjeljak, 18. 6. 2018.

Od travnja 2012. godine Američka akademija obiteljske medicine zajedno s više od 50 stručnih društava pokušava identificirati uobičajne testove, procedure i postupke liječenja koji moguće nisu potrebni ili korisni za pacijente. 24. rujna 2013. godine donijeli su treću po redu listu takvih postupaka. Između ostalog, preporuka je ne propisivati antibiotike za upale srednjeg uha u dobi 2-12 godina ukoliko simptomi nisu ozbiljni i ukoliko je moguće praćenje; nepotreban je rutinski skrining za karcinom prostate određivanjem PSA ili digitorektalnim pregledom; za propisivanje oralnih kontraceptiva nije potreban fizikalni pregled.

American Academy of Family Physicians Releases Third Choosing Wisely® List, Identifies Five Medical Procedures Doctors Should Question.

The AAFP’s new Choosing Wisely items are as follows:

1. Do not prescribe antibiotics for otitis media in children aged 2-12 years with non-severe symptoms where the observation option is reasonable.

The “observation option” refers to deferring antibacterial treatment of selected children for 48 to 72 hours and limiting management to symptomatic relief. The decision to observe or treat is based on the child’s age, diagnostic certainty, and illness severity. To observe a child without initial antibacterial therapy, it is important that the parent or caregiver has a ready means of communicating with the clinician. There also must be a system in place that permits reevaluation of the child.

2. Do not perform voiding cystourethrogram (VCUG) routinely in first febrile urinary tract infection (UTI) in children aged 2-24 months.

The risks associated with radiation (plus the discomfort and expense of the procedure) outweigh the risk of delaying the detection of the few children with correctable genitourinary abnormalities until their second UTI.

3. Do not routinely screen for prostate cancer using a prostate-specific antigen (PSA) test or digital rectal exam.

There is convincing evidence that PSA-based screening leads to substantial over-diagnosis of prostate tumors. Many tumors will not harm patients, while the risks of treatment are significant. Physicians should not offer or order PSA screening unless they are prepared to engage in shared decision making that enables an informed choice by patients.

4. Do not screen adolescents for scoliosis.

There is no good evidence that screening asymptomatic adolescents detects idiopathic scoliosis at an earlier stage than detection without screening. The potential harms of screening and treating adolescents include unnecessary follow up visits and evaluations due to false positive test results and psychological adverse effects.

5. Do not require a pelvic exam or other physical exam to prescribe oral contraceptive medications.

Hormonal contraceptives are safe, effective, and well tolerated for most women. Data do not support the necessity of performing a pelvic or breast examination to prescribe oral contraceptive medications. Hormonal contraception can be safely provided on the basis of medical history and blood pressure measurement.

 

As with its previous two lists, the new AAFP Choosing Wisely items were developed after months of careful consideration and review based on the most current medical evidence.

 

The AAFP is the only participating medical society to have released a Choosing Wisely list in all three phases of the campaign.

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