1 in 10 kids got unneeded medical services in 2014, U. of C. study says

At least 1 in 10 children received unnecessary medical services in 2014 — causing them potential harm and costing families more than $9 million, according to a study out of the University of Chicago.

The study found at least 9.6 percent of kids received one "low-value" medical service in 2014 — things like antibiotics for upper respiratory infections, cough and cold medication for children younger than 6 years old, tests for strep throat in kids younger than 3 years old and acid blockers for babies with mild reflux.

The study, published in the peer-reviewed journal Pediatrics late last month, looked at data for 4.4 million children across the country with private insurance.

"Overuse in pediatrics is widespread," said Dr. Kao-Ping Chua, lead author of the study and an assistant professor of pediatrics and public health sciences at the University of Chicago. In addition to driving up overall health care spending, overuse "can cause significant physical, emotional and financial harm to children and families," he said.

For example, antibiotics won't ease respiratory infections caused by viruses. Antibiotics only work for bacterial infections. But antibiotics can cause side effects, such as diarrhea, and the more antibiotics a person takes, the less effective they become over time, Chua said.

"This is a particularly important problem in kids because you're talking about people whose lives are completely ahead of them," Chua said. "When you breed this bacterial resistance early in life, it has lifetime effects."

Also, cough and cold medicines in young children can cause side effects like sedation, dizziness and elevated heart rate, without helping them, he said.

Acid blockers for babies also are often unnecessary, Chua said. It's normal for babies to spit up, and acid blockers should only be used when an infant's reflux is severe, causing pain or weight loss. Acid blockers are another drug that can have side effects, potentially affecting the kidneys, he said.

Chua said it sometimes can be difficult for pediatricians to turn down parents' requests for certain medications and services, even when the doctors know they might not help. Parents might be anxious about their children's symptoms and willing to try an antibiotic even if the parents know there's a chance it might not work.

"It's a very complicated issue because of parental concern, and I'm a parent myself so I understand that," Chua said.

But he said, ultimately, pediatricians are the gatekeepers.

Pediatricians might prescribe medications or order unnecessary tests because of parental worry, fear of misdiagnosing a patient or a lack of time, he said. "It's certainly easier to write a prescription than explain why something isn't necessary," Chua said.

Unnecessary tests and treatments for kids led to $27 million in spending in 2014, including $9.2 million paid out-of-pocket by families, according to the study.

The study's findings are in line with what other research has found when it comes to care for people of all ages. In May, a study by the Centers for Disease Control and Prevention and the Pew Charitable Trusts showed that nearly one-third of antibiotics prescribed in the U.S. were unnecessary.

Also, about three-fourths of doctors who took part in a 2014 American Board of Internal Medicine Foundation survey said the frequency of unnecessary tests or procedures is a serious problem. But about half of those doctors also said they order unnecessary tests if a patient insists.

"Over the last five to 10 years, there's been a growing national conversation about trying to reduce unnecessary care for patients of all ages," said Dr. Matthew Davis, division head of academic general pediatric and primary care at Lurie Children's Hospital in Chicago. Davis was not involved in the U. of C. study.

Davis said it's important to educate parents and doctors about unnecessary care. The American Board of Internal Medicine Foundation also runs a Choosing Wisely initiative, which lists on its website treatments that parents and physicians should question across many specialties, including pediatrics.

Reducing unnecessary care also may involve changing parents' expectations.

"In my experience, by having a conversation with parents about the value of specific tests or treatments, we can often come to agreement about trying to provide the highest value care possible," Davis said. "I find that most parents are receptive, especially when we talk about the possible harms that can come from low-value treatments and tests."

He recommends parents ask their kids' doctors about whether specific tests and treatments are likely to change outcomes for their children.

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