AMDA Releases Second Round of Potentially Unnecessary Medical Tests, Procedures a s Part of the ABIM Foundation’s Choosing Wisely ® Campaig

March 20, 2015
Perry Gwen Meyers,

Louisville, KY – AMDA – The Society for Post-Acute and Long-Term Care Medicine (AMDA) has partnered with the ABIM Foundation’s Choosing Wisely® campaign to encourage discussions among physicians, patients, and other health care stakeholders about medical tests and procedures that may be unnecessary or even cause harm. In September 2013, AMDA released a list of five practices or tests that are common in the post-acute/long-term care (PALTC) setting, but lack scientific evidence to support their use. Today, at AMDA’s 2015 Annual Conference, another five practices (6-10 below) or tests to question were released.

  1. Don’t insert percutaneous feeding tubes in individuals with advanced dementia. Instead, offer oral
    assisted feedings.
  2. Don’t use Sliding Scale Insulin for long-term diabetes management for individuals residing in the
    nursing home.
  3. Don’t obtain a urine culture unless there are clear signs and symptoms that localize to the urinary tract.
  4. Don’t prescribe antipsychotic medications for behavioral psychological symptoms of dementia (BPSD) in individuals with dementia without an assessment for an underlying cause of the behavior.
  5. Don’t routinely prescribe lipid-lowering medications in individuals with a limited life expectancy.
  6. Don’t place an indwelling urinary catheter to manage urinary incontinence.
  7. Don’t recommend screening for breast, colorectal or prostate cancer if life expectancy is estimated to be less than 10 years.
  8. Don’t obtain a C. difficile toxin test to confirm “cure” if symptoms have resolved.
  9. Don’t recommend aggressive or hospital-level care for a frail elder without a clear understanding of the individual’s goals of care and the possible benefits and burdens.
  10. Don’t initiate antihypertensive treatment in individuals ≥60 years of age for systolic blood pressure (SBP) <150 mm Hg or diastolic blood pressure (DBP) <90 mm Hg.

AMDA Clinical Practice Committee Chair Gwendolen T. Buhr, MD, MEd, CMD, who oversaw the development of list items 6-10, looks to the list to influence relationships between providers and patients. “AMDA is committed to improving the quality of post-acute and long-term care. We believe the discussions between patients and providers that will be stimulated from the items on this list will bring great progress towards our goal of always delivering the highest quality care.”

“More than 70 specialty societies have joined Choosing WiselyChoosing Wisely partners illustrates the pervasiveness of unnecessary care in our health care system, and it’s through the leadership of organizations like AMDA that we are making real progress to reduce waste and improve care for patients across the country.”

To view the full list, sources, and read about how this list was created, click here.

About AMDA – The Society for Post-Acute and Long-Term Care Medicine
AMDA – The Society for Post-Acute and Long-Term Care Medicine is the national professional association of medical directors, attending physicians, and other professionals practicing post-acute and long-term care medicine and committed to the continuous improvement of patient care. AMDA provides education, advocacy, information, and professional development to enable its members to deliver quality post-acute and long-term care.

About the ABIM Foundation
The mission of the ABIM Foundation is to advance medical professionalism to improve the health care system. We achieve this by collaborating with physicians and physician leaders, medical trainees, health care delivery systems, payers, policy makers, consumer organizations and patients to foster a shared understanding of professionalism and how they can adopt the tenets of professionalism in practice. To learn more about the ABIM Foundation, visi, read our blog, connect with us on Facebook o follow us on Twitter.

About Choosing Wisely®
First announced in December 2011, Choosing Wisely® is part of a multi-year effort led by the ABIM Foundation to support and engage physicians in being better stewards of finite health care resources. Participating specialty societies are working with the ABIM Foundation and Consumer Reports to share the lists widely with their members and convene discussions about the physician’s role in helping patients make wise choices. Learn more at