PCPs rank top medical innovations

High-tech scanning methods, such as magnetic resonance imaging, and innovations to treat cardiovascular disease were ranked as highly important to the care of patients in a survey of 225 primary care physicians published in Health Affairs (vol. 20, no. 5). At the bottom of the list was bone marrow transplant.

The survey raises important questions at a time when the Centers for Medicare and Medicaid Services (formerly HCFA) is considering a new rule that would mandate major reductions in Medicare reimbursements to hospitals and doctors for 1,100 "innovative and frequently used" outpatient procedures such as pacemaker implantation and chemotherapy. Such plans may cause hospitals and physicians to use these innovations less.

"The need to compare the value to patients of new technologies with their effect on spending is a major source of tension among physicians, hospitals, patients, insurance companies and government policy makers," said authors Victor R. Fuchs, Henry J. Kaiser Jr., professor emeritus at Stanford University, and Harold C. Sox Jr., former professor of medicine at Dartmouth College. "This is the first study to look at the relative value to patients of different innovations, as judged by leading general internists actively involved in patient care."

Varied responses

In a one-page survey, internists were asked to select, from a list of 30, the five to seven innovations whose loss would probably have the most adverse effects on patients, and the five to seven whose loss would have the least adverse effects. Physicians' assessments were similar regardless of geographic location, personal characteristics or type of practice, according to the authors.

A few innovations elicited considerable variance in response. For example, response to HIV testing and treatment was the most variable, followed closely by cataract extraction, prostate-specific-antigen testing (testing for prostate cancer) and opioids (such as morphine).

The authors found that highly variable responses to innovations like HIV testing were related to the characteristics of the patients the doctors see. For example, the average score for HIV testing and treatment rose sharply as the percentage of Medicaid patients increased. And physicians ranked the importance of cataract extraction and lens implant high if they treated a higher number of Medicaid patients and older patients.

In addition to patient type, physicians' age played a role in the rankings. For example, older physicians ranked the newer antidepressants as significantly less important to patients than did younger physicians.

According to Health Affairs, primary care physicians were chosen because, unlike specialists, they are in the best position to make comparisons of a variety of innovations, according to the study. The physicians surveyed were not a representative sample of all U.S. physicians, but were chosen by nomination of their peers based on how well-respected they are in the field and the credibility of their views. The physicians were predominantly male and considerably older than the average American physician, and represented all parts of the country. PR

Physicians' rankings of innovations

1  MRI and CT scanning

2  ACE inhibitors

3  Balloon angioplasty

4  Statins

5  Mammography

6  Coronary artery bypass grafting

7  Proton-pump inhibitors and H2 blockers

8  SSRIs and recent non-SSRI antidepressants

9  Cataract extraction and lens implant

10  Hip and knee replacement

Source: Authors' analysis of their survey, 2001