When an 80-year-old man visited his doctor and was recommended a routine prostate screening, an electronic health record flashed a dramatic yellow alert. The warning highlighted that the test was not recommended by guidelines and could lead to unnecessary care and potential health problems. This was part of a strategy tested by Northwestern Medicine investigators to reduce the persistent practice of ordering unnecessary screenings for older adults. The results, published in the Annals of Internal Medicine, showed a significant decrease in screenings for prostate cancer and urinary tract infections.
Over the course of 18 months, 370 clinicians across 60 Northwestern Medicine clinics received these alerts, resulting in a 9% reduction in unnecessary testing for prostate cancer and a 5.5% reduction for urinary tract infections. However, there was only a minimal change in the overtreatment of blood sugar, which also poses potential harm. Half of the physicians received the alerts, while the other half did not.
Lead investigator Dr. Stephen Persell, a professor of medicine at Northwestern University Feinberg School of Medicine and a Northwestern Medicine physician, stated that this study was the first to significantly reduce all unnecessary testing and treatments using point-of-care alerts. The effectiveness of these messages can be attributed to elements such as highlighting potential harms, sharing social norms, and promoting a sense of social accountability and reputational concerns.
Previous trials attempting to reduce overuse of testing through electronic health records have not been successful in changing clinicians’ behavior. However, Persell believes that if compelling messages can be delivered at the time clinicians place their orders, it could be a straightforward way to improve care across large health systems.
Unnecessary screening and overtreatment can lead to serious health problems for older adults. For instance, screening an elderly man for prostate cancer may result in overtreatment that could cause more harm than living with an indolent cancer. Similarly, testing women aged 65 and older for urinary tract infections without any symptoms can lead to unnecessary treatments, such as antibiotics, which can cause allergic reactions, diarrhea, and antibiotic resistance.
Persell emphasises the importance of tailoring medical decisions to an individual’s age and health condition. What might be appropriate for a 68-year-old man may not be suitable for someone who is 75 or 85 years old. Additionally, treating blood sugar to very low levels in older adults with certain drugs can put them at risk for dangerous low blood sugar events. However, changing patients’ and doctors’ goals regarding blood sugar interventions can be challenging.