Otolaryngologists Join Campaign Against Unnecessary Medical Testing

The American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) plans to join a campaign launched by the American Board of Internal Medicine (ABIM) Foundation that aims to reduce unnecessary medical tests and procedures. According to the ABIM, the campaign, “Choosing Wisely,” is an ongoing effort to encourage physicians to more actively engage in and take responsibility for ensuring the appropriateness of healthcare services offered based on the individual needs of patients.

The campaign began last year, and this April it released its first list of 45 overused or unnecessary tests and procedures as identified by nine specialty societies.

The AAO-HNS intends to publish its own list by the fall of 2012. According to David R. Nielsen, MD, executive vice president and CEO of AAO-HNS, the list will be developed by practicing otolaryngologists and head and neck surgeons with appropriate recognition of individual physician judgment, skill and responsibility to patients.

“The ‘Choosing Wisely’ campaign complements the Academy’s quality agenda that focuses on empowering physicians to provide the best patient care through the development of evidence-based guidelines as well as identifying tools, services and processes that lead to safe care in our specialty,” he said. He added that the campaign is not about telling physicians what to do but about asking the right questions.

“It’s about physicians with patients choosing the best care that is supported by evidence,” he said.

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AAAI: 5 Unnecessary and Overused Tests and Procedures

AAAAI Recommendations

The American Academy of Allergy, Asthma and Immunology (AAAAI) was among the specialty societies that initially submitted a list of five tests or procedures identified as potentially unnecessary or overused. It recommends:

• Don’t perform unproven diagnostic tests, such as immunoglobulin G testing or an indiscriminate battery of immunoglobulin E tests, in the evaluation of allergy.
• Don’t order sinus computed tomography or indiscriminately prescribe antibiotics for uncomplicated acute rhinosinusitis.
• Don’t routinely perform diagnostic testing in patients with chronic urticaria.
• Don’t recommend replacement immunoglobulin therapy for recurrent infections unless impaired antibody responses to vaccines are demonstrated.
• Don’t diagnose or manage asthma without spirometry.

Holly Boyer, MD, an assistant professor of otolaryngology at the University of Minnesota Medical School in Minneapolis who isn’t involved in the campaign, said the guidelines are on target and confirm what she already does in clinical practice. Her only caveat, she said, is that the list does not go one step further and emphasize the potential harms of unnecessary tests and procedures. “Not only does this campaign reduce the number of unnecessary tests and procedures, but it also will reduce the side effects of unnecessary tests and procedures,” she said.

Joining the Campaign

According to Linda Cox, MD, president-elect of AAAAI, the five items on the list submitted were chosen by a core workgroup, the members of which relied on selected experts and member input as well as evidence from previously vetted and published guidelines.