As part of the ABIM Foundation's "Choosing Wisely" campaign, the American Academy of Family Physicians (AAFP) has released its third set of five medical procedures to discuss in depth before ordering. (Examiner coverage of other Choosing Wisely lists can be found here and here.) The AAFP is an original member of the ABIM Foundation's Choosing Wisely campaign, having been part of the effort since its launch in April 2012.
The full set of AAFP guidelines can be found here. It includes cautions regarding the overuse of antibiotics, such as "Don't routinely prescribe antibiotics for acute mild-to-moderate sinusitis unless symptoms last for seven or more days, or symptoms worsen after initial clinical improvement." In addition to the well-known danger of breeding antibiotic-resistant bacteria, the AAFP is concerned with the expense and unnecessary side effects associated with overuse of antibiotics: "Despite consistent recommendations to the contrary, antibiotics are prescribed in more than 80% of outpatient visits for acute sinusitis. Sinusitis accounts for 16 million office visits and $5.8 billion in annual healthcare costs."
The new set of five guidelines echoes the first in its authors' concern for the overuse of antibiotics. "Don't prescribe antibiotics for otitis media [middle ear infection] for children aged two to twelve years with non-severe symptoms where the observation option is reasonable." The AAFP explains that the "observation option" is appropriate when the child's caregiver can readily communicate with the clinician for 48 to 72 hours from the onset of symptoms, and involves providing relief of symptoms rather than antibiotics while monitoring the child for this period of time.
In a move sure to be welcomed by sixth-graders nationwide, the AAFP also advises clinicians not to screen asymptomatic adolescents for scoliosis. "There is no good evidence," the guideline states, "that screening asymptomatic adolescents detects idiopathic scoliosis at an earlier stage than detection without screening." The AAFP further states, "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."
The next set of Choosing Wisely guidelines are scheduled for release by the American Association of Clinical Toxicology and the American College of Medical Toxicology on September 26, 2013.