| chronic pain

The A, B, Cs of De-Escalating Routine Primary Care

New Guidelines Needed for Scaling Back Treatment

According to an article in JAMA, “…most guidelines focus on escalating care and provide few explicit recommendations to stop or scale back (ie, deintensify) treatment and testing” of medical services for chronic conditions or prevention. The article authors recommend “Stopping these services when the evidence changes or if the benefits no longer outweigh the risks is essential.” Their objective is “To develop a systematic, transparent, and reproducible approach for identifying, specifying, and validating deintensification recommendations associated with routine adult primary care.”

Panel members—25 physicians from the VA and US academic institutions specializing in geriatrics, women’s health, endocrinology, etc—reviewed guidelines/recommendations and sought to find ways to “identify and prioritize potential deintensification indications.” 178 opportunities to stop/reduce routine primary care services were identified; the top 37 were deemed valid. The study concluded, “The next steps should include assessing how often we fail to deintensify when indicated, tracking intended and unintended outcomes of deintensification efforts, developing patient-centered and policy solutions for deintensification, and testing and evaluating theory-based approaches for change.”


Read the journal article.