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EVOLVE: The Australian Rheumatology Association's 'top five' list of investigations and interventions doctors and patients should question

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posted on 2023-05-19, 15:27 authored by Morrisroe, K, Nakayama, A, Soon, J, Arnold, M, Barnsley, L, Barrett, C, Brooks, PM, Hall, S, Hanrahan, P, Hissaria, P, Graeme JonesGraeme Jones, Katikireddi, VS, Keen, H, Laurent, R, Nikpour, M, Poulsen, K, Robinson, P, Soden, M, Wood, N, Cook, N, Hill, C, Buchbinder, R
Background: The EVOLVE (evaluating evidence. enhancing efficiencies) initiative aims to drive safer, higher-quality patient care through identifying and reducing low-value practices.

Aims: To determine the Australian Rheumatology Association's (ARA's) 'top 5' list of low-value practices.

Methods: A working group comprising 19 rheumatologists and three trainees compiled a preliminary list. Items were retained if there was strong evidence of low-value and there was high or increasing clinical use and/or increasing cost. All ARA members (356 rheumatologists and 72 trainees) were invited to indicate their 'top 5' list from a list of 12 items via MonkeySurvey in December 2015 (reminder February 2016) .

Results: 179 rheumatologists (50.3%) and 19 trainees (26.4%) responded. The top 5 list (percent of rheumatologists including item in their top 5 list) was: Do not perform arthroscopy with lavage and/or debridement for symptomatic osteoarthritis of the knee nor partial meniscectomy for a degenerate meniscal tear (73.2%); Do not order ANA testing without symptoms and/or signs suggestive of a systemic rheumatic disease (56.4%); Do not undertake imaging for low back pain for patients without indications of an underlying serious condition (50.8%)​; Do not use ultrasound guidance to perform injections into the subacromial space as it provides no additional benefit in comparison to landmark-guided injection (50.3%)​; and Do not order anti dsDNA antibodies in ANA negative patients unless the clinical suspicion of SLE remains high (45.3%).

Conclusions: This list is intended to increase awareness among rheumatologists, other clinicians and patients about commonly used low-value practices that should be questioned.

History

Publication title

Internal Medicine Journal

Volume

48

Pagination

135-143

ISSN

1444-0903

Department/School

Menzies Institute for Medical Research

Publisher

Blackwell Publishing Asia

Place of publication

54 University St, P O Box 378, Carlton, Australia, Victoria, 3053

Rights statement

Copyright 2017 Internal Medicine Journal

Repository Status

  • Restricted

Socio-economic Objectives

Clinical health not elsewhere classified

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