Gastroenterologists are the exception in a report that finds most public hospital specialists are doing few or declining numbers of  low-value care procedures.

A review of 27 procedures included in Choosing Wisely lists or the RACP’s EVOLVE initiatives has found that only three procedures  – colonoscopy for constipation, endoscopy for dyspepsia and sentinel lymph node biopsy for melanoma in situ – showed increasing trends in NSW hospitals.

Overall, about half of the procedures surveyed had negligible levels of low value care and most of the remainder showed declining use over time, according to the analysis by the University of Sydney’s Menzies Centre for Health Policy.

“Low-value care in this Australian public hospital setting is not common for most of the measured procedures,” the researchers said.

But about 16% of all endoscopy episodes in adults were defined as low value care because they were for dyspepsia. These procedures cost of up to to $17 million a year in NSW hospitals and rates were increasing by as much as 9% annually.

About 5% of colonoscopies in public hospitals were deemed low value care because they were for constipation, and cost about $13 million, with rates increasing 5% annually.

The researchers said low value care accounted for substantial resources in terms of dollars and bed days in some hospitals.

They also noted that their analysis was limited to procedures on Choosing Wisely lists, which have been criticised by some for including many low impact items.

“The 27 procedures are those we could measure, not necessarily the most important for health system efficiency or patient outcomes, and clinicians in Australia may not have recognised these services as requiring action,” they commented.

For the gastroenterology procedures identified with significant levels of low value episodes there should be further investigation of the drivers to determine what can be done to reduce the use, they suggested.

Feedback of the results and the use of possible restrictions such as requiring  ‘permissions’ for procedures could help reduce low value procedures, they suggest.

However, “any action based on these results needs to be carefully considered, to avoid undermining the clinician goodwill associated with Choosing Wisely,” they warn.

Significant Low Value Care, Increasing Trend 

• Endoscopy in adults <55
• Colonoscopy in adults <50
• Sentinel lymph node biopsy

Significant Low Value Care, Decreasing Trend 

• Knee arthroscopy
• Hysterectomy
• Endovascular repair of abdominal aortic aneurysm
• Percutaneous coronary intervention
• Carotid endarterectomy
• Renal artery angioplasty
• Vena cava filters
• Surgery for vesicoureteric reflux
• ERCP
• Spinal fusion
• Epidural steroid injection

Negligible Number of Low Value Care Episodes

• Vertebroplasty
• Bariatric surgery
• Nasolacrimal probe in infants
• Vertebral biopsy
• Retinal laser or cryotherapy
• Hyperbaric oxygen
• Laparoscopic uterine nerve ablation
• Gall bladder removal during bariatric surgery
• Electrotherapy
• Pelvic lymphadenectomy
• Endometrial biopsy
• Radiotherapy after radical prostatectomy
• Electroconvulsive therapy in children