(HealthDay News) – In the United States from 1999–2009, the delivery of underused care in the ambulatory setting improved, but fewer changes were seen in inappropriate care, according to a study published online Dec. 24 in the Archives of Internal Medicine.

To examine the rates of overuse and misuse of health care services in the ambulatory setting, Minal S. Kale, MD, from the Mount Sinai School of Medicine in New York City, and colleagues conducted a cross-sectional analysis of the 1999 and 2009 National Ambulatory Medical Care Survey and the outpatient department component of the National Hospital Ambulatory Medical Care Survey.

In six of nine underuse quality indicators, the researchers identified a significant improvement: use of antithrombotic therapy for atrial fibrillation; use of aspirin, β-blockers, and statins in coronary artery disease; use of β-blockers in congestive heart failure; and use of statins in diabetes mellitus. In eight of 11 overuse quality indicators there was no change; an improvement was seen in two indicators (significant decreases in the overuse of cervical cancer screening for older women >65 and overuse of antibiotics in asthma exacerbations); and one indicator became worse (increase in overuse of prostate cancer screening in men over 74 years). There was an improvement in one of the two misuse indicators.

“Reducing health care costs and improving the quality of care in the United States can be achieved by reducing overuse and misuse of health care services, but it will require making uncomfortable decisions that patients, physicians, and policymakers have been historically unwilling to make,” the authors write.

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