Study Finds Variation in Intensification vs. Deintensification Guideline Recommendations

Current guidelines for diabetes and cardiovascular disease management provide more recommendations for intensification than deintensification of routine services, according to a research letter published Dec. 18 in JAMA: Internal Medicine.

Adam A. Markovitz, BS, et al., examined guidelines for both diabetes and cardiovascular disease released by seven major guideline developers, from January 2012 through April 2016. The study included the services provided in the ambulatory setting, to the same patient over time, and under a primary care physician's discretion.

Results showed that out of 361 recommendations, 256 (71 percent) were categorized as intensification and 105 (29 percent) were categorized as deintensification. The authors also found a large difference in how frequently guideline developers recommend deintensification, suggesting developers' inconsistency with existing evidence on benefit and harm. Of recommendations backed by strong evidence, only 17 percent (17 of 99) addressed deintensification vs. 83 percent (82 of 99) that addressed intensification.

Furthermore, the authors explain that the reason for intensifying treatment is often due to more evidence regarding intensification. They add that performance measures rarely address overuse.

The authors conclude that "where clinical data are sparse, developers should demonstrate equal restraint in recommending intensification versus deintensification." They add, "where evidence for harm is strong, developers should provide specific guidance in the form of clear recommendations, algorithms, and decision support tools on when, how, and for whom to stop or scale back care."

Keywords: Physicians, Primary Care, Diabetes Mellitus, Research, Publications, Internal Medicine, Cardiovascular Diseases, Algorithms

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