Article type
Year
Abstract
Background: Overdiagnosis is the diagnosis of a medical condition that would never have caused any symptoms or problems to patients. This sort of diagnosis can be harmful, and can lead to psychological and physical stress and unnecessary treatments to patients, and unjustifiable costs to healthcare systems. It is not the same as a misleading diagnosis (wrong diagnosis). Overdiagnosis is now considered to be a problem for patients, clinicians, researchers, and policymakers. Addressing unnecessary diagnoses - overdiagnosis - using the principles of evidence-based health (EBH) is a major challenge to practitioners and policymakers.
Objective: To report the experience of professionals applying EBH principles in a Family Health Unit struggling against unnecessary screening or routine tests, in order to prevent overdiagnosis.
Methods: This is a descriptive study about an experiment in which primary-care health professionals applied the principles of EBH and Cochrane evidence to try to raise attention to overdiagnosis in a single Family Health Unit in the city of Petrópolis, Rio de Janeiro state, Brazil. This study was conducted in a partnership with Faculdade de Medicina de Petrópolis (Petrópolis Medical School), and was performed between March and June 2016.
Results: During the period studied, 25 visits showed some indication for a test or examination according to the team judgments. After a round of debate and critical analysis of indications, benefits and harms of the tests in the light of the EBH, we ascertained that in 52% of the cases we should avoid requests provided there was not a precise indication; in 28% of the cases we remained uncertain and in only 20% of the cases we maintained the decision to request the tests.
Conclusions: Overdiagnosis is a worldwide concern and our local experience was no different. In this single-center, observational study with a small sample size, we observed that judicious use of the evidence according to Sacket's principles, critical thinking, and peer discussion would be a promising route to avoiding the risk of overdiagnosis.
Patient or healthcare consumer involvement: We are planning permanent education campaigns to healthcare professionals and patients about overdiagnosis, as a keypoint towards a more appropriate, useful health care.
Objective: To report the experience of professionals applying EBH principles in a Family Health Unit struggling against unnecessary screening or routine tests, in order to prevent overdiagnosis.
Methods: This is a descriptive study about an experiment in which primary-care health professionals applied the principles of EBH and Cochrane evidence to try to raise attention to overdiagnosis in a single Family Health Unit in the city of Petrópolis, Rio de Janeiro state, Brazil. This study was conducted in a partnership with Faculdade de Medicina de Petrópolis (Petrópolis Medical School), and was performed between March and June 2016.
Results: During the period studied, 25 visits showed some indication for a test or examination according to the team judgments. After a round of debate and critical analysis of indications, benefits and harms of the tests in the light of the EBH, we ascertained that in 52% of the cases we should avoid requests provided there was not a precise indication; in 28% of the cases we remained uncertain and in only 20% of the cases we maintained the decision to request the tests.
Conclusions: Overdiagnosis is a worldwide concern and our local experience was no different. In this single-center, observational study with a small sample size, we observed that judicious use of the evidence according to Sacket's principles, critical thinking, and peer discussion would be a promising route to avoiding the risk of overdiagnosis.
Patient or healthcare consumer involvement: We are planning permanent education campaigns to healthcare professionals and patients about overdiagnosis, as a keypoint towards a more appropriate, useful health care.