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Table 1 The scope of medical overuse in primary care

From: Medical overuse and quaternary prevention in primary care – A qualitative study with general practitioners

Statutory health insurance ↔ Individual health services ↔ Private health insurance

Over investigation

 Laboratory diagnostics

 Holter-ECG/Long-term blood pressure control

 Ultrasound (thyroid, abdomen)

 General check-up in asymptomatic patients

 PSA screening in asymptomatic patients

 “Extended prevention investigation” in asymptomatic patients: Ultrasound, ECG, ergometry, spirometry, laboratory diagnostics

 GP-recommended self-diagnostic devices (blood glucose/blood pressure)

Overtreatment

 Polymedication in general (often discrepancies after hospital discharge)

 Physical therapy covered by health insurance for new unspecific back pain

 Broad-spectrum antibiotics for uncomplicated community acquired pneumonia (CAP)

 Injections for back pain relief

 Antibiotics for viral infections

 Long-term prescription of benzodiazepines

 Opioid therapy in chronic non-cancerous pain

 Vitamine replacement therapy

Referrals to out-patient secondary care: GP-, specialist- or patient-driven

 Specialist visits for basic medical problems: uncomplicated hypertonia, diabetes, new unspecific back pain

 Referrals to MR Imaging for new unspecific back pain