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How To Achieve Better Primary Care: Top 5 Lists Explain

Posted By Richard Scott, Wednesday, May 25, 2011
Updated: Wednesday, May 25, 2011

Primary care stands as the gateway for most patients as they interact with the healthcare system. Physicians check symptoms, recommend treatment and prescribe medication. With these high-touch – and high-cost – areas affecting the daily decisions of patients, what if all primary care interventions hinged on optimal, and financially sound, care provision?

That’s what a group of physicians wanted to know. After lengthy research and peer polling, a group of doctors from the National Physicians’ Alliance brought together a best-practice list of modified interventions that, when applied to areas like medication and imaging, could save money and conserve limited resources.

The group National Physicians’ Alliance researchers launched a project called "Promoting Good Stewardship in Clinical Practice” that set its sights on improving the quality of care in family medicine, internal medicine and pediatrics.

In each of the three primary care specialties, working groups of NPA members focused their recommendation common practices that are evidence-based and "that would lead to significant health benefits and reduce risks, harms and costs,” according to the study that appeared in the Archives of Internal Medicine.

The end result produced a "Top 5” list of recommended interventions or changes in practice for each of the three specialty areas. The top five recommendations for each specialty are as follows:

Family Medicine

  1. Hold off on lower back imaging for six weeks unless warning signs are present.
  2. Limit use of antibiotics for sinus infections, as research shows most infections are viral.
  3. Do not assess cardiac screening in patients who are low risk or are without symptoms.
  4. For women under 21, avoid Pap tests for cervical cancer.
  5. Limit use of bone density scans called dual-energy X-ray absorptiometry (DEXA) for the assessment of osteoporosis to women over 65 and men over 70 with risk factors.

Internal Medicine

  1. Put off or defer imaging for lower back pain.
  2. Resist ordering the lengthy blood chemistry panels, using blood lipid tests instead, in adults with no symptoms.
  3. In healthy patients, do not order cardiac screening.
  4. When prescribing statins, recommend generic brands.
  5. Only order bone density tests for at-risk patients.


  1. Do not prescribe antibiotics for sore throat without a positive strep throat test.
  2. Resist imaging for minor head injuries unless there are key risk factors.
  3. Do not immediately refer patients with ear infections to specialists; instead, see how the patient progresses.
  4. Following CDC guidelines, advise parents to avoid over-the-counter cough medicines and cold medicines.
  5. Ensure that asthmatic patients use corticosteroid steroids correctly to limit avoidable episodes.

View the article from the Archives of Internal Medicine. What do you think about the lists? Send your response to Editor Richard Scott.

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