The French Society of Internal Medicine’s Top-5 List of Recommendations: a National Web-Based Survey
The international project “Choosing Wisely” aims to target unnecessary and potentially harmful examinations and treatments.
To define the French Internal Medicine Top-5 list.
Based on a review of existing Top-5 lists and personal experience, a working group of the French National Society of Internal Medicine selected 27 diagnostic and therapeutic procedures. They were submitted through a national web-based survey to French internists who rated from 1 to 5 the perceived frequency, uselessness, and risk of each procedure. A composite score was calculated as the unweighted addition of the three scores.
Four hundred thirty internists answered the web-based survey (14% of all French internists including residents). All the French regions and status of the profession were represented.
For the 27 submitted procedures, the mean score (± SD) was 3.25 (± 0.48) for frequency, 3.10 (± 0.43) for uselessness, and 2.63 (± 0.84) for risk.
Do not prescribe long-term treatment with proton pump inhibitors without regular reevaluation of the indication
Do not administer preventive treatments (e.g., for dyslipidemia, hypertension…) in elderly people with dementia when potential risks outweigh the benefits
Do not administer hypnotic medications as first-line treatment for insomnia
Do not treat with an anticoagulant for more than 3 months a patient with a first venous thromboembolism occurring in the setting of a major transient risk factor
Do not screen for Lyme disease without an exposure history or related clinical examination findings
We found that the composite score was strongly correlated to the risk score (rs = 0.88, p < 10−5) and not to the frequency (rs = 0.06, p = 0.75) or uselessness score (rs = 0.17, p = 0.38).
This Top-5 list provides an opportunity to discuss appropriate use of health care practices in internal medicine.
KEY WORDSChoosing Wisely overmedicalization internal medicine inappropriate prescribing
We thank the SNFMI (French National Society of Internal Medicine) and the Junior Internist Association (AJI) for their support for this work.
We thank the FHF (Fédération Hospitalière de France) and the EFIM (European Federation of Internal Medicine) which were at the origin of this work.
We thank Thibaud Pitel and the Sentinelles network for their assistance in carrying out the web-based survey.
We thank the volunteers who tested the website and all the participants in the survey.
We are grateful to three anonymous reviewers whose insight improved this article.
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they do not have a conflict of interest.
- 3.Too much medicine. Br Med J. http://www.bmj.com/too-much-medicine. Accessed 25 Oct 2017.
- 9.Conseil National de l’Ordre des Médecins. Atlas de La Démographie Médicale En France.; 2016.Google Scholar
- 10.Rapports à la Comission des comptes de la sécurité sociale. Les Prescriptions d’IPP.; 2009. http://www.securite-sociale.fr/IMG/pdf/ccss200910_fic-10-3.pdf.
- 14.Farrell B, Pottie K, Thompson W, et al. Deprescribing proton pump inhibitors: Evidence-based clinical practice guideline. Can Fam Physician 2017;63(5):354–364.Google Scholar
- 15.Deprescribing.org. Evidence-based deprescribing algorithm for proton pump inhibitors. http://www.open-pharmacy-research.ca/wordpress/wp-content/uploads/ppi-deprescribing-algorithm-cc.pdf. Published 2016. Accessed 28 Nov 2017.
- 19.Morin L, Vetrano DL, Rizzuto D, Calderon-Larranaga A, Fastbom J, Johnell K. Choosing Wisely? Measuring the Burden of Medications in Older Adults near the End of Life: Nationwide, Longitudinal Cohort Study. Am J Med 2017;130(8):927–936.e9. https://doi.org/10.1016/j.amjmed.2017.02.028.CrossRefGoogle Scholar
- 21.Riemann D, Baglioni C, Bassetti C, et al. European guideline for the diagnosis and treatment of insomnia. J Sleep Res 2017. https://doi.org/10.1111/jsr.12594.
- 24.Glass J. Sedative hypnotics in older people with insomnia: meta-analysis of risks and benefits. BMJ. 2005;331(7526):1169–0. https://doi.org/10.1136/bmj.38623.768588.47.
- 25.Airagnes G, Pelissolo A, Lavallée M, Flament M, Limosin F. Benzodiazepine Misuse in the Elderly: Risk Factors, Consequences, and Management. Curr Psychiatry Rep 2016;18(10). https://doi.org/10.1007/s11920-016-0727-9.
- 27.Boutitie F, Pinede L, Schulman S, et al. Influence of preceding length of anticoagulant treatment and initial presentation of venous thromboembolism on risk of recurrence after stopping treatment: analysis of individual participants’ data from seven trials. BMJ. 2011;342:d3036.CrossRefGoogle Scholar
- 28.Middeldorp S, Prins MH, Hutten BA. Duration of treatment with vitamin K antagonists in symptomatic venous thromboembolism. Cochrane Database Syst Rev 2014;(8):CD001367. https://doi.org/10.1002/14651858.CD001367.pub3.
- 29.Kearon C, Akl EA, Comerota AJ, et al. Antithrombotic therapy for VTE disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141(2 Suppl):e419S-e496S. https://doi.org/10.1378/chest.11-2301.CrossRefGoogle Scholar
- 32.Dessau RB, van Dam AP, Fingerle V, et al. To test or not to test? Laboratory support for the diagnosis of Lyme borreliosis: a position paper of ESGBOR, the ESCMID study group for Lyme borreliosis. Clin Microbiol Infect 2017. https://doi.org/10.1016/j.cmi.2017.08.025.
- 36.Wormser GP, Dattwyler RJ, Shapiro ED, et al. The clinical assessment, treatment, and prevention of lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis 2006;43(9):1089–1134. https://doi.org/10.1086/508667.CrossRefGoogle Scholar
- 37.Markowicz M, Kivaranovic D, Stanek G. Testing patients with non-specific symptoms for antibodies against Borrelia burgdorferi sensu lato does not provide useful clinical information about their aetiology. Clin Microbiol Infect 2015;21(12):1098–1103. https://doi.org/10.1016/j.cmi.2015.08.005.CrossRefGoogle Scholar
- 38.Horvath K, Siebenhofer A. The Choosing Wisely Initiative: A critical analysis with a special focus on primary care. Z Evid Fortbild Qual Gesundh Wes 2017. https://doi.org/10.1016/j.zefq.2017.10.015.
- 46.ABIM Foundation. American Board of Internal Medicine. Choosing Wisely. http://www.choosingwisely.org. Accessed 25 Oct 2017.
- 51.Société Suisse de Médecine Interne Générale. Smarter Medicine - Médecine Interne Générale. 2016.Google Scholar