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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