Top ten ways to prevent overuse and underuse in children’s health

By Judith Garber | March 19, 2019

Overuse in pediatrics, while still an often-overlooked issue, is starting to gain more recognition. A few weeks ago, children’s health researchers published a collection of the most influential new research on pediatric overuse. And now, researchers are identifying and advocating for changes in clinical practice to reduce both underuse and overuse in children’s health.

In the newest edition of the American Family Physician, members of the Right Care Alliance Children’s Health Council Dr. Matthew Schefft, Dr. Alan R. Schroeder, Dr. Diane Liu, Dr. Daniel Nicklas, Dr. Justin Moher, and Dr. Ricardo Quinonez present their final list of top “Do’s and Don’ts” for preventing both overuse and underuse in pediatrics.

The Right Care Top Ten has been years in the making. In 2016, each of the Right Care Alliance councils began developing a list of 10 evidence-based recommendations for health care value in their specialty. Through a modified Delphi panel process, the Children’s Health council voted for what they considered the most important recommendations, based on how much the recommendation matters for patients, its potential for positive impact, and how well it illustrates broader system failures.

Here are a few highlights from the top ten list:

Making sure that children with attention-deficit/hyperactivity disorder have access to behavioral therapies such as cognitive behavior therapy, parent training, classroom behavioral management, peer interventions, can help avoid the expense and side effects of medication.
Providing free, age-appropriate books to parents at the doctor’s office or hospital can help improve childhood literacy, which is linked to better long-term health outcomes.
Routine prescribing of antibiotics for children with a middle ear infection provides only a minimal benefit in pain reduction and should be avoided.
For children with minor head trauma, clinicians should consider that computed tomography (CT) scans may cause more harm than benefit, because it increases radiation exposure. Incidental findings from head CTs can also lead to overdiagnosis and overtreatment.

For the full list of Do’s and Don’ts for Right Care in Children’s Health, see the AFP article here!

To eliminate medication overload, serious cultural, educational, and policy changes are needed. This action plan offers recommendations for policymakers, health care institutions, clinicians, and patients across five key categories to reduce harm from multiple medication use. Suggested Citation: Eliminating medication overload: A national action plan. Working Group on Medication Overload. Brookline, MA: The Lown Institute, 2020. DOI: https://doi.org/10.46241/LI.YLBW4885

Pharmaceutical marketing is a significant factor in the growing public health crisis of medication overload, which puts millions of older adults at risk of preventable harm and premature death. This issue brief provides recommendations to reduce pharmaceutical industry influence by limiting pharma sales rep visits to clinicians and direct-to-consumer advertising.

This issue brief provides recommendations for clinical practice guidelines and electronic health records that would give clinicians the information they need to appropriately prescribe and deprescribe.