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When it’s better to stop or decrease health care services and interventions: researchers bring validity and transparency to deintensification recommendations in primary care.

Kerr EA, et al. Identifying recommendations for stopping or scaling back unnecessary routine services in primary care. JAMA Intern Med. 2020;180(11):1500-1508. doi:10.1001/jamainternmed.2020.4001

A recent study published in JAMA Internal Medicine examined and validated recommendations for avoiding unnecessary and excessive health care services in primary care settings. Dr. Eve Kerr and team at the University of Michigan and the Ann Arbor VA point to the need to stop or scale back care when it is no longer indicated or when the benefits outweigh the harms. However, while many recommendations exist for increasing care, there is a dearth of practical, specific recommendations for deintensifying routine services. The study team identified 409 recommendations to stop or scale back care. The study team then consolidated and prioritized these guidelines and presented 37 recommendations to an expert panel to review using a modified Delphi approach. The expert panel reviewed evidence and suggested modifications to these recommendations. Examples include tapering long-term benzodiazepines in older adults using these medications to treat insomnia and stopping or decreasing insulin, sulfonylureas and/or thiazolidinediones within 3 months of a low HbA1c in older adults with an HbA1c lower than 7% at risk for hypoglycemia. As noted by the authors, these specific, actionable recommendations may be implemented and used to develop consolidated guidelines to fit varied primary care settings. Studying implementation efforts of deintensification recommendations, applying behavior change theory, and drafting systems-level policies are all important next steps to see that care is adjusted appropriately for adults in primary care. Dr. Kerr states, “we hope this can be a reproducible process for identifying and specifying opportunities to deintensify care, with enough information to guide measurement.”

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