The top ten overuse studies of 2018

Each year, JAMA Internal Medicine publishes an update on overuse featuring the top ten most influential articles on overuse from the previous year. Below are some highlights from this year’s update, from researchers Dr. Daniel J. MorganDr. Sanket S. Dhruva, Dr. Eric R. CoonDr. Scott M. Wright, and Dr. Deborah Korenstein.

Here are a few interesting findings from the from the top ten articles on overuse:

  • A study by Sadigh et al found that 9% of older women with advanced colorectal or lung cancer were given screening mammograms, and 11% of these women received follow-up breast imaging, even though it is not recommended that women with advanced cancers be screened for breast cancer.
  • For patients at the lowest risk of developing lung cancer, it takes screening 6903 to prevent 1 lung cancer death, according to a study by Caverly et al. However, for patients at high risk of lung cancer, the balance of benefits and harms surpasses those of most established cancer screening programs.
  • A study by Palms et al. found that unnecessary antibiotic prescriptions for viral illnesses occur often in urgent care centers. Almost half (45.7%) of patient visits for viral illnesses resulted in an antibiotic prescription at urgent care centers, compared to 24.6% in emergency departments and 17% in primary care office visits.
  • In states that added a certain type of malpractice cap, physicians ordered 24% fewer initial coronary angiograms and performed 23% less revascularization compared to physicians in non-cap states, according to Farmer et al.

Trends in overuse research

Since 2016, the number of articles on overuse identified by the research team has declined. In 2016, there were 1,224 articles published on overuse in high-impact journals. In 2017 there were 910 and in 2018 the number declined again to 839. Is the medical research community’s interest in overuse waning?

Not necessarily, say Morgan and Korenstein. “[The decline] might be real or it might relate to the words people are using to classify the literature,” said Korenstein. As research in overuse has gotten more sophisticated, researchers are using more specific terms to define their research rather than just”overuse,” such as “overdiagnosis” or “overtreatment.” So the word “overuse” may not show up in the study search even though it falls under the larger overuse umbrella. “I don’t think there is less research as much as better quality and more pointed,” said Morgan.

Morgan and Korenstein did note that articles on overuse are improving in quality. In past years, overuse research was focused on evaluating quality improvement projects to reduce overuse. Now researchers are beginning to look even more meaningful measures, such as the harms of overuse.

“Overall, I think the shift toward more meaningful research is a positive one,” said Korenstein.

To read all of the top ten articles and summaries, check out the Update in JAMA Internal Medicine.