martes, 20 de agosto de 2013

Potenciar los recursos sanitarios escasos, tomando decisiones clínicas sensatas (Choosing Wisely)

Los médicos de Estados Unidos están cada vez más comprometidos con una estrategia de reducir intervenciones escasamente efectivas, inseguras, inclementes o insensatas.

A esto le llaman "eligiendo sensatamente".

Muchos pensamos que es una buena vía para ensayar medidas de racionalización, alternativas a los recortes y exclusiones.

Aquí viene una buena lista de iniciativas; os pego las de medicina preventiva... pero hay de muchas otras áreas...

Repu

Choosing Wisely: More Good Clinical Recommendations to Improve Health Care Quality and Reduce Harm



http://www.aafp.org/afp/2013/0801/p164.html#afp20130801p164-ut1

Preventive medicine

Don't perform routine annual cervical cytology screening (Pap tests) in women 30 to 65 years of age.16
ACS/ASCCP/ASCP, ACOG guidelines
Don't screen women younger than 30 years for cervical cancer with HPV testing, alone or in combination with cytology.2
USPSTF
Don't screen women older than 65 years for cervical cancer who have had adequate prior screening and are not otherwise at high risk for cervical cancer.2
USPSTF
Don't perform Pap tests in patients younger than 21 years or in women after hysterectomy for benign disease.2*
ACOG (for age), USPSTF (for hysterectomy)
Don't screen for ovarian cancer in asymptomatic women at average risk.16
USPSTF
Don't use positron emission tomography/CT for cancer screening in healthy individuals.8
Expert consensus
Don't perform routine cancer screening for dialysis patients with limited life expectancies without signs or symptoms.18*
American Society of Nephrology
Don't repeat colorectal cancer screening (by any method) for 10 years after a high-quality colonoscopy is negative in average-risk individuals.12*
U.S. Multi-Society Task Force on Colorectal Cancer
Don't use DEXA to screen for osteoporosis in women younger than 65 years or in men younger than 70 years with no risk factors.2*
American Association of Clinical Endocrinologists, American College of Preventive Medicine, NOF, USPSTF

NOTE: Risk factors include, but are not limited to, fractures after 50 years of age, prolonged exposure to corticosteroids, diet deficient in calcium or vitamin D, cigarette smoking, alcoholism, and thin/small build.
Don't routinely repeat DEXA scans more often than once every two years.22
USPSTF, NOF
Don't perform population-based screening for 25-OH-vitamin D deficiency.15
Endocrine Society guideline
Don't screen for carotid artery stenosis in asymptomatic adult patients.2
USPSTF

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