Kathleen Morrisroe1,2, Ayano Nakayama3,4, Jason Soon5,6, Mark Arnold7, Les Barnsley8, Claire Barrett9, Peter M Brooks10, Stephen Hall11, Patrick Hanrahan12, Pravin Hissaria13, Graeme Jones14, Veera S Katikireddi15, Helen Keen12,16, Rodger Laurent17, Mandana Nikpour1,2, Katherine Poulsen15, Philip Robinson18, Muriel Soden19,20, Nigel Wood21, Nicola Cook22, Catherine Hill23, Rachelle Buchbinder24,25. 1. Department of Rheumatology, St Vincent's Hospital, Sydney, New South Wales, Australia. 2. Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia. 3. Rheumatology Department, Canberra Hospital, Canberra, Australian Capital Territory, Australia. 4. College of Medicine, Biology and Environment, Australian National University, Canberra, Australian Capital Territory, Australia. 5. Royal Australasian College of Physicians, Sydney, New South Wales, Australia. 6. Menzies Centre for Health Policy, Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia. 7. School of Rural Health, University of Sydney, Sydney, New South Wales, Australia. 8. Department of Rheumatology, Concord Repatriation General Hospital, Sydney, New South Wales, Australia. 9. Department of Rheumatology, Redcliffe Hospital, Brisbane, Queensland, Australia. 10. Centre for Health Policy, School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia. 11. Department of Medicine, Monash University and Cabrini Health, Melbourne, Victoria, Australia. 12. Department of Medicine, University of Western Australia, Perth, Western Australia, Australia. 13. Department of Immunology, SA Pathology, Clinical Immunology Unit, Royal Adelaide Hospital and University of Adelaide, Adelaide, South Australia, Australia. 14. Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia. 15. Department of Medicine, The Prince Charles Hospital, Brisbane, Queensland, Australia. 16. Department of Rheumatology, Royal Perth Hospital and Fiona Stanley Hospital, Perth, Western Australia, Australia. 17. Department of Rheumatology, Royal North Shore Hospital, Sydney, New South Wales, Australia. 18. School of Medicine, Royal Brisbane Hospital, University of Queensland, Brisbane, Queensland, Australia. 19. Department of Rheumatology, The Townsville Hospital, Townsville, Queensland, Australia. 20. College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia. 21. Department of Rheumatology, University Hospital Geelong, Geelong, Victoria, Australia. 22. Department of Rheumatology, Royal Perth Hospital, Perth, Western Australia, Australia. 23. Rheumatology Unit, The Queen Elizabeth and Royal Adelaide Hospital and University of Adelaide, Adelaide, South Australia, Australia. 24. Monash Department of Clinical Epidemiology, Cabrini Institute, Melbourne, Victoria, Australia. 25. Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
Abstract
BACKGROUND: The EVOLVE (evaluating evidence, enhancing efficiencies) initiative aims to drive safer, higher-quality patient care through identifying and reducing low-value practices. AIMS: To determine the Australian Rheumatology Association's (ARA) 'top five' list of low-value practices. METHODS: A working group comprising 19 rheumatologists and three trainees compiled a preliminary list. Items were retained if there was strong evidence of low value and there was high or increasing clinical use and/or increasing cost. All ARA members (356 rheumatologists and 72 trainees) were invited to indicate their 'top five' list from a list of 12-items through SurveyMonkey in December 2015 (reminder February 2016). RESULTS: A total of 179 rheumatologists (50.3%) and 19 trainees (26.4%) responded. The top five list (percentage of rheumatologists, including item in their top five list) was: Do not perform arthroscopy with lavage and/or debridement for symptomatic osteoarthritis of the knee nor partial meniscectomy for a degenerate meniscal tear (73.2%); Do not order anti-nuclear antibody (ANA) testing without symptoms and/or signs suggestive of a systemic rheumatic disease (56.4%); Do not undertake imaging for low back pain for patients without indications of an underlying serious condition (50.8%); Do not use ultrasound guidance to perform injections into the subacromial space as it provides no additional benefit in comparison to landmark-guided injection (50.3%) and Do not order anti-double-stranded DNA antibodies in ANA negative patients unless the clinical suspicion of systemic lupus erythematosus remains high (45.3%). CONCLUSIONS: This list is intended to increase awareness among rheumatologists, other clinicians and patients about commonly used low-value practices that should be questioned.
BACKGROUND: The EVOLVE (evaluating evidence, enhancing efficiencies) initiative aims to drive safer, higher-quality patient care through identifying and reducing low-value practices. AIMS: To determine the Australian Rheumatology Association's (ARA) 'top five' list of low-value practices. METHODS: A working group comprising 19 rheumatologists and three trainees compiled a preliminary list. Items were retained if there was strong evidence of low value and there was high or increasing clinical use and/or increasing cost. All ARA members (356 rheumatologists and 72 trainees) were invited to indicate their 'top five' list from a list of 12-items through SurveyMonkey in December 2015 (reminder February 2016). RESULTS: A total of 179 rheumatologists (50.3%) and 19 trainees (26.4%) responded. The top five list (percentage of rheumatologists, including item in their top five list) was: Do not perform arthroscopy with lavage and/or debridement for symptomatic osteoarthritis of the knee nor partial meniscectomy for a degenerate meniscal tear (73.2%); Do not order anti-nuclear antibody (ANA) testing without symptoms and/or signs suggestive of a systemic rheumatic disease (56.4%); Do not undertake imaging for low back pain for patients without indications of an underlying serious condition (50.8%); Do not use ultrasound guidance to perform injections into the subacromial space as it provides no additional benefit in comparison to landmark-guided injection (50.3%) and Do not order anti-double-stranded DNA antibodies in ANA negative patients unless the clinical suspicion of systemic lupus erythematosus remains high (45.3%). CONCLUSIONS: This list is intended to increase awareness among rheumatologists, other clinicians and patients about commonly used low-value practices that should be questioned.
Authors: Parth K Modi; Samuel R Kaufman; Tudor Borza; Bryant W Oliphant; Andrew M Ryan; David C Miller; Vahakn B Shahinian; Chad Ellimoottil; Brent K Hollenbeck Journal: Surg Innov Date: 2018-11-30 Impact factor: 2.058
Authors: Vivek Vasdev; S K Patnaik; D S Bhakuni; K Shanmuganandan; A Bhayana; G Mullick; A Hegde; Ashwini Kumar; Abhishek Kumar; R Singh Journal: Med J Armed Forces India Date: 2020-07-09
Authors: Denise A O'Connor; Paul Glasziou; Christopher G Maher; Kirsten J McCaffery; Dina Schram; Brigit Maguire; Robert Ma; Laurent Billot; Alexandra Gorelik; Adrian C Traeger; Loai Albarqouni; Juliet Checketts; Parima Vyas; Brett Clark; Rachelle Buchbinder Journal: JAMA Date: 2022-09-06 Impact factor: 157.335
Authors: James J Tsakas; David F L Liew; Cameron L Adams; Catherine L Hill; Susanna Proudman; Samuel Whittle; Rachelle Buchbinder; Philip C Robinson Journal: BMC Rheumatol Date: 2022-10-17