Reducing overuse of PSA screening in primary care practices.

Abstract

37 Background: The United States Preventive Services Task Force and the American Urological Association both recommend against routine PSA-based screening for prostate cancer in men 70 years and older and, for men younger than 70, recommend shared-decision making to discuss the potential benefits and harms of screening before a PSA is ordered. The HIT-OVERUSE study was a 2 year group randomized study from August 2016 thru July 2018 to test a practice-based intervention to reduce overuse in primary care practices, including avoidance of routine PSA screening without shared decision-making. The purpose of this report is present the impact of this intervention on PSA screening. Methods: Twenty one primary care practices in 19 states volunteered to participate in the study. Prior to randomization, all providers received academic detailing on prostate cancer screening recommendations. Eleven practices randomized to the intervention group then received quarterly performance reports, hosted site visits for participatory planning and sent two practice representatives to a one day meeting to share ‘best practices’. The ten control practices only received performance reports. Changes in PSA testing in the past year (excluding patients with prostate cancer) were compared in control and intervention practices. Results: At the patient level, there was a significantly larger unadjusted reduction in PSA screening in men ages 40 to 69 in the past year between intervention practices (28.6 % to 19.0%) and control practices (16.5% to 12.7%) (p<0.0001). There was also a significantly larger unadjusted reduction in PSA screening in men ages 70 and older in the past year between intervention practices (25.7% to 14.7%) and control practices (21.9% to 15.6%) (p<0.0001). Adjusted changes will also be presented. Conclusions: A practice-based intervention to reduce routine PSA-screening performed without shared decision-making resulted in a greater reduction in PSA screening compared to provision of academic detailing alone. Further research could elucidate whether this type of intervention results in increased shared decision-making conversations with patients.