Effect of Behavioral Intervention on Reducing Care Overuse in Seniors Not Sustained
MONDAY, Feb. 10, 2025 -- Clinical decision support (CDS) aimed at reducing overuse of care in seniors does not yield durable changes in terms of prostate-specific antigen (PSA) screening in older men, but is durable for reducing urinary overtesting, according to a research letter published online Feb. 11 in the Annals of Internal Medicine.
Lucia C. Petito, Ph.D., from the Northwestern University Feinberg School of Medicine in Chicago, and colleagues examined whether the effectiveness of a behavioral intervention to reduce overtesting and overtreatment of older adults in three areas persisted in the 12 months after intervention discontinuation. The pragmatic, cluster randomized controlled trial was conducted at 60 primary care practices in Chicago, which enrolled 371 clinicians to receive intervention (CDS delivered through the electronic health record) or control for 18 months.
The researchers found that the intervention group, but not the control group, had an increase in the annual rate of PSA testing per 100 patients during the postintervention year. Per 100 eligible patients, the annual rate of urinalysis or urine culture was lower in the intervention versus the control group at the end of the postintervention period; neither rate changed meaningfully during the following year. At the beginning of the postintervention period, the annual rate of diabetes overtreatment per 100 eligible patients was slightly lower in the intervention group, but rates were indistinguishable between the intervention and control groups at the end of the postintervention period.
"These findings suggest that to maintain benefits, CDS interventions aimed at reducing low-value care should generally be left in place or be provided on a less frequent schedule to reduce alert fatigue," the authors write.
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