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The French Society of Internal Medicine’s Top-5 List of Recommendations: a National Web-Based Survey

  • Nathan Peiffer-SmadjaEmail author
  • Adeline Bauvois
  • Marie Chilles
  • Baptiste Gramont
  • Redwan Maatoug
  • Marie Bismut
  • Camille Thorey
  • Eric Oziol
  • Thomas Hanslik
Article

Abstract

Background

The international project “Choosing Wisely” aims to target unnecessary and potentially harmful examinations and treatments.

Objective

To define the French Internal Medicine Top-5 list.

Design

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.

Participants

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.

Key Results

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.

The Top-5 list obtained with the composite score was as follows:
  1. 1.

    Do not prescribe long-term treatment with proton pump inhibitors without regular reevaluation of the indication

     
  2. 2.

    Do not administer preventive treatments (e.g., for dyslipidemia, hypertension…) in elderly people with dementia when potential risks outweigh the benefits

     
  3. 3.

    Do not administer hypnotic medications as first-line treatment for insomnia

     
  4. 4.

    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

     
  5. 5.

    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).

Conclusions

This Top-5 list provides an opportunity to discuss appropriate use of health care practices in internal medicine.

KEY WORDS

Choosing Wisely overmedicalization internal medicine inappropriate prescribing 

Notes

Acknowledgments

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.

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Copyright information

© Society of General Internal Medicine 2019

Authors and Affiliations

  • Nathan Peiffer-Smadja
    • 1
    • 2
    Email author
  • Adeline Bauvois
    • 1
    • 2
  • Marie Chilles
    • 1
  • Baptiste Gramont
    • 1
  • Redwan Maatoug
    • 1
  • Marie Bismut
    • 1
  • Camille Thorey
    • 1
  • Eric Oziol
    • 3
  • Thomas Hanslik
    • 3
  1. 1.Junior Internist AssociationAmicale des Jeunes Internistes (AJI)ParisFrance
  2. 2.Assistance Publique – Hôpitaux de ParisHôpital Bichat-Claude BernardParisFrance
  3. 3.French National Society of Internal MedicineSociété Nationale Française de Médecine Interne (SNFMI)ParisFrance

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