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Table 2 List of prioritized guideline recommendations for protection against the overuse and underuse of health care

From: Protection against the overuse and underuse of health care – methodological considerations for establishing prioritization criteria and recommendations in general practice

Clinical guideline   Recommendation (short) Protection against…a Reference
Prevention/risk factor reduction
 Cough 1 Recommendation for regular documentation of smoking status in smokers with cough Underuse [38]
 Asthma 2 Recommendation for prevention of passive smoking Underuse [39]
 Back pain 3 Recommendation for physical activity in the prevention of back pain and back pain related sick leave Underuse [40]
 Skin cancer prevention 4 Recommendation against general skin cancer screening Overuse [42]
 Alcohol-related disorders 5 Recommendation against general screening for at-risk drinking in primary care setting Overuse [43]
 Prostate cancer 6 Recommendation against general PSA screening.
Recommendation for a discussion of the pros and cons in patients asking for advice
Overuse [44]
 Sore throat 7 Recommendation for Centor Score and McIsaac Score to determine when to perform a throat swab Overuse [45]
 Fatigue 8 Recommendation for two-question depression screening in patients with unspecific fatigue Underuse [41]
9 Recommendation for basic diagnostics in every patient with fatigue (anamnesis, physical examination, blood work) Underuse [41]
10 Recommendation against cancer diagnostics in patients with fatigue and no further signs of cancer Overuse [41]
 Chest pain 11 Recommendation for Marburg Heart Score for estimating the probability of ischemic heart disease in patients with chest pain in the primary care setting Overuse and Underuse [46]
12 Recommendation on coronary angiography only if defined diagnostic or therapeutic benefit is present Overuse [46]
 Diabetic neuropathy 13 Recommendation on comprehensive diabetic foot examination Underuse [47]
 Chronic congestive heart failure 14 Recommendation for echocardiography in every patient with congestive heart failure Underuse [48]
15 Recommendation for echocardiography reports including an interpretation of the result Underuse [48]
 Dementia 16 Recommendation for limiting imaging in dementia patients to those with possibly treatable disease Overuse [49]
 Back pain 17 Recommendation against imaging in uncomplicated acute back pain Overuse [40]
 Sore throat 18 Recommendation for patient-doctor discussion of the inappropriateness of antibiotics against viral infections Overuse [45]
 Cough 19 Recommendation on rational antibiotic treatment of CAP Overuse [38]
20 Recommendation against antibiotics in acute uncomplicated bronchitis Overuse [38]
21 Recommendation against regular use of neuraminidase inhibitors in seasonal influenza Overuse [38]
22 Recommendation against expectorants in acute infectious cough Overuse [38]
 Diabetes – treatment 23 Recommendation for discontinuing diabetes medication when therapeutic goal is reached with minimal drug dose Overuse [50]
24 Recommendation for rational HbA1c targets in patients with type 2 diabetes Overuse [50]
 Diabetic foot 25 Recommendation on correct management of diabetic foot ulcers Underuse [51]
 Chronic congestive heart failure 26 Recommendation against inappropriate medicines in patients with chronic congestive heart failure Overuse [48]
27 Recommendation for ACE inhibitors in patients with reduced ejection fraction Underuse [48]
28 Recommendation for beta blockers in patients with congestive heart failure Underuse [48]
 Dementia 29 Recommendation for stopping drug treatment for dementia if dementia is exacerbated Overuse [49]
 Back pain 30 Recommendation against IV or IM medications in unspecific acute or chronic back pain Overuse [40]
31 Recommendation against IV NSAIDs in back pain Overuse [40]
 Chronic ischemic heart disease 32 Recommendation for statin therapy without dose adjustment Overuse [52]
Long-term care in primary care setting
 Diabetes – treatment 33 Recommendation against regular monitoring of the lipid response to statin therapy Overuse [50]
 Chronic congestive heart failure 34 Recommendation for appropriate management of elevated creatinine in patients with chronic congestive heart failure Underuse [48]
35 Recommendation on content of regular control examinations Underuse [48]
36 Recommendation for encouraging physical exercise in patients with stable congestive heart failure Underuse [48]
37 Recommendation for weight monitoring in patients with congestive heart failure Underuse [48]
 Dementia 38 Recommendation for additional focus on well-being of family members of a patient with dementia in primary care setting Underuse [49]
  1. aBased on the mean scores of the prioritization criteria “Relevance for overuse of health care” and “Relevance for underuse of health care” assigned by the clinically active authors of the guideline “Protection against the overuse and underuse of health care”. A difference larger than one point between the means of the two criteria determined the category (protection against overuse vs. underuse). If the difference was one point or smaller, the recommendation was regarded as relevant for both overuse and underuse