5 tests to avoid in long-term care settings

Five practices or tests commonly performed in post-acute and long-term care settings lack scientific evidence to support their use, according to the AMDA, formerly the American Medical Directors Association. The organization released a list of potentially unnecessary or harmful procedures today as part of the Choosing Wisely campaign, which the AMDA joined in January in the campaign’s third phase.

Practices, tests or procedures making the AMDA’s list:

• The insertion of percutaneous feeding tubes in individuals with advanced dementia. Oral assisted feedings should be offered instead, according to the organization.
• The use of sliding scale insulin for long-term diabetes management in individuals living in nursing homes.
• The attainment of a urine culture without clear signs and symptoms that localize to the urinary tract.
• The prescription of antipsychotic medications for behavioral psychological symptoms of dementia in individuals with dementia without the performance of an assessment for an underlying cause of the behavior.
• The routine prescription of lipid-lowering medications in individuals with limited life expectancy.

“By partnering in the Choosing Wisely campaign, our hope is that physicians and patients will talk about the necessity of these tests and procedures and [that] the quality of patient care will improve,” says AMDA Executive Director Christopher Laxton. “We believe that the conversations that occur as a result of this campaign will encourage open communication between physicians and patients, families and others. This, in turn, will promote and support the high-quality, cost-effective, person-centered care that AMDA and our members advocate for on a daily basis.”

The Choosing Wisely campaign was launched in 2012. Thirty-four national organizations are working with the American Board of Internal Medicine Foundation in the effort to identify and publicize lists specific to their specialties. The lists, each containing five practices or tests, are based on current scientific evidence about management and treatment options. Thirty more participating societies are expected to release recommendations through March 2014.

The AMDA is serving as a representative of the long-term care field. The list released today was devised by members of a clinical practice committee convened by the AMDA and then was approved by the AMDA’s executive committee.

Healthcare decision-making increasingly is a team activity involving practitioners, caregivers, patients/residents and their families, says Naushira Pandya, MD, one of the AMDA members who participated on the workgroup. The AMDA list will help dispel myths and misperceptions as members of these groups try to work together, she adds.

Susan Levy, MD, who helped develop the AMDA’s list, concurs. “These kinds of partnerships are critical in the new world of medicine. We can have productive discussions around the most common and most controversial issues in post-acute/long-term care,” she says.

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Lois Bowers

Lois A. Bowers was senior editor of I Advance Senior Care / Long-Term Living from 2013-2015.