Blog | Wednesday, September 25, 2013

QD: News Every Day--AAFP adds PSA tests, pelvic exams for The Pill to its Choosing Wisely list


The American Academy of Family Physicians released its third list of duplicative or unnecessary tests and procedures, which now includes routine prostate-specific antigen tests and pelvic exams for oral contraceptives, as part of the ABIM Foundation’s Choosing Wisely campaign.

This third list accompanies two previous ones, the organization said in a press release.

1) Do not prescribe antibiotics for otitis media in children aged 2-12 years with non-severe symptoms where the observation option is reasonable.

The “observation option” refers to deferring antibacterial treatment of selected children for 48 to 72 hours and limiting management to symptomatic relief. The decision to observe or treat is based on the child’s age, diagnostic certainty, and illness severity. To observe a child without initial antibacterial therapy, it is important that the parent or caregiver has a ready means of communicating with the clinician. There also must be a system in place that permits reevaluation of the child.

2) Do not perform voiding cystourethrogram (VCUG) routinely in first febrile urinary tract infection (UTI) in children aged 2-24 months.

The risks associated with radiation (plus the discomfort and expense of the procedure) outweigh the risk of delaying the detection of the few children with correctable genitourinary abnormalities until their second UTI.

3) Do not routinely screen for prostate cancer using a prostate-specific antigen (PSA) test or digital rectal exam.

There is convincing evidence that PSA-based screening leads to substantial overdiagnosis of prostate tumors. Many tumors will not harm patients, while the risks of treatment are significant. Physicians should not offer or order PSA screening unless they are prepared to engage in shared decision making that enables an informed choice by patients.

4) Do not screen adolescents for scoliosis.

There is no good evidence that screening asymptomatic adolescents detects idiopathic scoliosis at an earlier stage than detection without screening. The potential harms of screening and treating adolescents include unnecessary follow up visits and evaluations due to false positive test results and psychological adverse effects.

5) Do not require a pelvic exam or other physical exam to prescribe oral contraceptives.

Hormonal contraceptives are safe, effective, and well tolerated for most women. Data do not support the necessity of performing a pelvic or breast examination to prescribe oral contraceptive medications. Hormonal contraception can be safely provided on the basis of medical history and blood pressure measurement.

“The AAFP has shown tremendous leadership by releasing its list of test and procedures,” said Richard J. Baron, MD, FACP, 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.”

Launched in April 2012, Choosing Wisely is a national effort that has brought together more than 50 medical specialty societies, including ACP, to identify common tests, procedures and medications that may not be necessary or beneficial to patients.