09:38am Sunday 20 October 2019

AGA Releases List of Commonly Used, But Not Always Necessary, Tests or Procedures

Bethesda, MD  — The American Gastroenterological Association (AGA) released a list of “Five Things Physicians and Patients Should Question” in gastroenterology as part of Choosing Wisely®, an initiative of the ABIM Foundation.  The list identifies five targeted, evidence-based recommendations that can support physicians in working with their patients to make wise choices about their care.

AGA’s list identified the following recommendations:

  1. For pharmacological treatment of patients with gastroesophageal reflux disease (GERD), long-term acid suppression therapy (proton pump inhibitors or histamine2 receptor antagonists) should be titrated to the lowest effective dose needed to achieve therapeutic goals.
  2. Do not repeat colorectal cancer screening (by any method) for 10 years after a high-quality colonoscopy is negative in average-risk individuals.
  3. Do not repeat colonoscopy for at least five years for patients who have one or two small (< 1 cm) adenomatous polyps, without high-grade dysplasia, completely removed via a high-quality colonoscopy.
  4. For a patient who is diagnosed with Barrett’s esophagus, who has undergone a second endoscopy that confirms the absence of dysplasia on biopsy, a follow-up surveillance examination should not be performed in less than three years, as per published guidelines.
  5. For a patient with functional abdominal pain syndrome (as per ROME III criteria) computed tomography (CT) scans should not be repeated unless there is a major change in clinical findings or symptoms.

“As stewards in promoting and managing the delivery and use of our nation’s health-care resources, gastroenterologists need to ask important questions about the care patients receive,” said Lawrence R. Kosinski, MD, MBA, AGAF, chair, AGA Institute Practice Management and Economics Committee. “As part of our longstanding efforts to address the issues associated with health-care utilization, the AGA is proud to join the ABIM Foundation and many other respected medical societies in the Choosing Wisely campaign, which aims to build a more sustainable health-care system that delivers high-quality, effective care. AGA’s participation in Choosing Wisely is a natural extension of our years of work defining quality gastroenterological care and giving gastroenterologists tools for working with patients. We hope that partnering with these specialty societies will significantly impact the health-care system.”

All the lists released today as part of Choosing Wisely were developed by the partner organizations after careful consideration and review over many months. Using the most current evidence about management and treatment options within their specialty areas of expertise, the “Five Things” lists include recommendations that can make the biggest impact on patient care, safety and quality
Download AGA’s list of five things, with evidentiary statements, resources and information on how the list was created. Learn more about Choosing Wisely and read all nine lists at www.ChoosingWisely.org.

AGA’s list was created by a work group that included: John I. Allen, MD, MBA, AGAF; Craig J. Bakken, CMPE; Sandee Bernklau, APRN-BC; William C. Bray, MD, AGAF; Joel V. Brill, MD, AGAF; Catherine P. Cheney, MD, AGAF; Spencer David Dorn, MD; Yngve T. Falck-Ytter, MD, AGAF; Dawn L. Francis, MD, MHS; John W. Garrett, MD; Michael J. Goldberg, MD, AGAF; Peter D.R. Higgins, MD, PhD, MSc; John M. Inadomi, MD, AGAF; Rajeev Jain, MD, AGAF; Thomas F. Jones, MD; Fay Kastrinos, MD, MPH; Jeanette Keith, MD; Lawrence S. Kim, MD, AGAF; Lawrence R. Kosinski, MD, MBA, AGAF; Michael Carl Larsen, MD; Kirsten Teaney Weiser, MD;  and Andrew Tinsley, MD.

Also working with the ABIM Foundation to lead the campaign is Consumer Reports, the nation’s leading expert, independent, nonprofit consumer organization. Several organizations have joined Consumer Reports to distribute patient-friendly resources for consumers and physicians to engage in these important conversations:

  • AARP
  • Alliance Health
  • Midwest Business Group on Health
  • National Business Coalition on Health
  • National Business Group on Health
  • National Center for Farmworker Health
  • National Partnership for Women and Families
  • Pacific Business Group on Health
  • Leapfrog Group
  • Service Employees International Union
  • The Wikipedia Community (through a dedicated Wikipedian-in-Residence)

Eight other national medical specialty societies released individual lists of recommendations, covering tests or procedures within their areas of expertise that are commonly used, but not always necessary. By creating and releasing the lists, the groups aim to spark nationwide conversations between physicians and patients about the need — or lack thereof — for many frequently ordered tests or treatments.

Experts agree that the current way health care is delivered in America contains too much waste — some say that as much as 30 percent of care delivered in the U.S. is duplicative or unnecessary and may not improve people’s health.

The Choosing Wisely campaign seeks to help physicians, patients and other health-care stakeholders think and talk about overuse or misuse of health-care resources. It is part of the ABIM Foundation’s goal of promoting wise choices by clinicians and patients in order to improve health-care outcomes, provide patient-centered care that avoids unnecessary and even harmful interventions, and reduce the rapidly-expanding costs of the health-care system.

Releasing lists along with AGA are:

  • American Academy of Allergy, Asthma & Immunology
  • American Academy of Family Physicians 
  • American College of Cardiology 
  • American College of Physicians
  • American College of Radiology
  • American Society of Clinical Oncology
  • American Society of Nephrology
  • American Society of Nuclear Cardiology

New societies joining the campaign and releasing lists in fall 2012 include:

  • American Academy of Hospice and Palliative Medicine
  • American Academy of Otolaryngology–Head and Neck Surgery
  • American College of Rheumatology
  • American Geriatrics Society
  • American Society for Clinical Pathology
  • American Society of Echocardiography
  • Society of Hospital Medicine
  • Society of Nuclear Medicine

To learn more about Choosing Wisely, visit www.ChoosingWisely.org.


About the AGA Institute

The American Gastroenterological Association is the trusted voice of the GI community. Founded in 1897, the AGA has grown to include 17,000 members from around the globe who are involved in all aspects of the science, practice and advancement of gastroenterology. The AGA Institute administers the practice, research and educational programs of the organization. www.gastro.org.

Become an AGA fan on Facebook.
Join our LinkedIn group.
Follow us on Twitter @AmerGastroAssn.
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About the ABIM Foundation

The mission of the ABIM Foundation is to advance medical professionalism to improve the health care system. We achieve this by collaborating with physicians and physician leaders, medical trainees, health care delivery systems, payers, policy makers, consumer organizations and patients to foster a shared understanding of professionalism and how they can adopt the tenets of professionalism in practice. To learn more about the ABIM Foundation, visit www.abimfoundation.org, connect with us on Facebook or follow us on Twitter.

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