Columbia, MD — AMDA – Dedicated to Long Term Care Medicine (AMDA) has partnered with the ABIM Foundation’s Choosing Wisely® campaign to encourage discussions among physicians, patients, and other health care stakeholders about medical tests and procedures that may be unnecessary or even cause harm.
As part of this commitment, AMDA has developed a list of five practices or tests that are common in the post-acute/long-term care setting, but lack the scientific evidence to support their use. The list consists of:
- Don’t insert percutaneous feeding tubes in individuals with advanced dementia. Instead, offer oral assisted feedings.
- Don’t use Sliding Scale Insulin for long-term diabetes management for individuals residing in the nursing home.
- Don’t obtain a urine culture unless there are clear signs and symptoms that localize to the urinary tract.
- Don’t prescribe antipsychotic medications for behavioral psychological symptoms of dementia (BPSD) in individuals with dementia without an assessment for an underlying cause of the behavior.
- Don’t routinely prescribe lipid-lowering medications in individuals with a limited life expectancy.
To develop this list, AMDA convened a work group comprised of Clinical Practice Committee members. Group members suggested tests and procedures they thought should be included, which were then analyzed for appropriateness, relevance, and potential to improve patient care. They were further refined to maximize the impact and eliminate overlap. Then the group ranked the items according to importance. After a literature search to provide supporting evidence, the list was modified and finalized. The final list then went to the AMDA Executive Committee for approval.
“By partnering in the Choosing Wisely campaign, our hope is that physicians and patients will talk about the necessity of these tests and procedures, and the quality of patient care will improve,” said AMDA Executive Director Christopher Laxton, CAE. “We believe that the conversations that occur as a result of this campaign will encourage open communication between physicians and patients, families, and others. This, in turn, will promote and support the high-quality, cost-effective, person-centered care that AMDA and our members advocate for on a daily basis,” Laxton added.
“AMDA has shown tremendous leadership by releasing its list of tests and procedures they say are commonly done in post-acute/long term care but aren’t always necessary,” said Richard J. Baron, MD, president and CEO of the ABIM Foundation. “The content of this list and all of the others developed through this effort are helping physicians and patients across the country engage in conversations about what care they need, and what we can do to reduce waste and overuse in our health care system.”
Over the next year, more than 30 other specialty society partners will release lists as part of the Choosing Wisely campaign. Visit www.amda.com/tools/choosingwisely.cfm for AMDA’s full list and descriptions, information on how the list was created, and sources, as well as a JAMDA article on the list, quotes from those involved in the list development, and tools and resources related to list topics.