Patients who visit hospital-based primary care clinics as opposed to community-based clinics are more likely to receive tests or services with little diagnostic or therapeutic value, according to a study published in JAMA Internal Medicine.
Researchers compared low-value service use after primary care visits at hospital-based clinics to community-based clinics and also at hospital-owned versus physician-owned community-based clinics. Specifically, they compared use of antibiotics for upper respiratory tract infection, computed tomography or MRI for back pain and headache, radiographs for upper respiratory tract infection and back pain, and specialty referrals.
While hospital- and community-based clinics had similar antibiotic prescription rates, researchers found the low-value tests and services like MRIs, CT scans and specialty referrals occurred more often in hospital-based settings compared to community-based clinics.
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"Hospital-based practices need to be aware of their tendency to overuse certain tests and services of questionable therapeutic value for patients with uncomplicated conditions," said Bruce Landon, MD, the study's senior author. "That knowledge can help both front-line clinicians and hospital leadership find ways to eliminate, or at least reduce, such unnecessary services."
Patients were also more likely to receive more low-value services if they were not seeing their usual physician.
"Not seeing your regular primary care physician — what we call discontinuity of care — might be a weak spot where low-value care can creep in," Dr. Landon said. "The more we know about what situations are most likely to lead to patients receiving low-value care, the more we can do to prevent it."