We have taken an interest over the past few years in our journal in sharing with you studies and special articles that promote value in the care we deliver through improvements in quality and reductions in cost. Sometimes we do that by pointing out flaws in our system such as what can be done to prevent overdiagnosis of some conditions (10.1542/peds.2014-1778—Moyer et al.) and this week, we focus on overuse of tests and treatments that are not evidence-based and do not improve the health of our patients despite their convenience and availability.
Coon et al. (10.1542/peds.2016-2797) identify for us where overuse is most rampant despite the evidence telling us not to order the many tests and treatments we do--be it in too many radiographs for viral illness, use of intravenous antibiotics when orals can be just as effective (e.g. with ongoing treatment of osteomyelitis) and most recently the need to use hypertonic saline when more recent evidence would suggest that should not be the case. Even our intent to use phototherapy may be an overkill if our thresholds to do so are lower than studies suggest they be. We know from some prior studies in our journal that we can reduce overuse when the data is overwhelming such as the need to reduce the frequency of CT scans due to the risk of over-radiation —but here is more work to be done—and this study should make us aware of what each of us can do to reduce overuse in our outpatient or inpatient settings.
Can you think of other overuse situations not mentioned in this article or do you agree with those that are discussed? Do you think overuse is even a problem for pediatricians compared to our adult colleagues? We would welcome your thoughts and ideas on this topic by responding to this blog, commenting on our website or posting a thought on our Facebook or Twitter sites—all of which should be put to good use after you read this important special article.