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Choosing wisely in case of hypertension, diabetes and hyperlipidemia in older patients

Choosing wisely – für Hypertonie, Diabetes und Hyperlipidämie bei Älteren anwendbar?

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Summary

Background

The Choosing WiselyTM campaign was created by the American Board of Internal Medicine, it asks medical specialty societies to indicate five diagnostic and/or therapeutic interventions in their specialty to be avoided in specific cases. The aim of this campaign is to stimulate discussion between patients and their doctors about the usefulness of each procedure and also to avoid unnecessary, possibly wasteful measures. Hypertension, diabetes and hyperlipidemia are the most common conditions seen in primary care. The feasibility of applying the principles of Choosing Wisely in these cases was the target of this mini-review.

Methods

A PUBMED query based on entering the terms “choosing wisely”, “elderly”, “hypertension”, “diabetes” and “hyperlipidemia” was performed. The search was limited to studies in human subjects using original articles and reviews in English and German that were published in the period of 1982–2015. In addition, a manual search from all relevant references and screened articles was performed.

Conclusion

Using the up to date knowledge of precise indication for the pharmacological treatment of hypertension, diabetes and hyperlipidemia in older patients protects them from adverse effects and avoids interventions of low value.

Additional tests of functionality like a frailty score or the comprehensive geriatric assessment can improve decision making for starting of medical interventions and for adjusting the intensity of treatment. Based on current literature they can help to withdraw or to abstain from unnecessary medical interventions.

Zusammenfassung

Grundlagen

Die „Choosing WiselyTM“-Initiative wurde vom American Board of Internal Medicine ins Leben gerufen. Die medizinischen Fachgesellschaften wurden aufgerufen, fünf diagnostische und/oder therapeutischen Maßnahmen aufzuzeigen, die in bestimmten Fällen zu unterlassen sind. Dadurch sollte die Diskussion zwischen Patienten und ihren Ärzten über die Sinnhaftigkeit von medizinsichen Maßnahmen angeregt werden und unsinnige vermieden werden. Die häufigsten Diagnosen im niedergelassenen Bereich sind Hypertonie, Diabetes und Hyperlipidämie. Das Ziel dieser Mini-Übersicht ist die Klärung der Frage nach der Anwendbarkeit der Prinizipien von „Choosing wisely“ für diese Krankheitsbilder.

Methodik

Unter Verwendung der Begriffe „choosing wisely“, „elderly“, „hypertension“, „diabetes“ und „hyperlipidemia“ wurde eine PUBMED Recherche durchgeführt. Die Suche wurde auf Orginalarbeiten an Patienten und Übersichtsartikeln zum Thema limitiert. Artikel, die in deutscher oder englischer Sprache im Zeitraum von 1982 und 2015 erschienen, wurden einbezogen und zusätzlich eine manuelle Suche nach relevanten Artikeln, die in den Referenzen aufschienden, durchgeführt.

Schlussfolgerung

Gemäß dem aktuellen Wissen über die pharmakologische Behandlung der Hypertonie, Diabetes und Hyperlipidämie bei älteren Patienten ist es möglich, Interventionen von geringem Wert zu vermeiden und Patienten vor Nebenwirkungen zu schützen. Zusätzliche Erhebungen der Funktionaliät dieser Patienten, wie z.B. mittels Frailty-Score oder dem Geriatrischen Assessment, verbessern die Entscheidungsgrundlage für die Wahl der Intensität der Diagnostik und Behandlung. Die Evidenzlage hilft bei der Entscheidung, unnötige medizinische Interventionen zu unterlassen oder zurückzunehmen.

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  1. Department of Acute Geriatrics, Salzkammergutklinikum Gmunden, Miller von Aichholzstraße 49, 4810, Gmunden, Österreich

    Peter Dovjak

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Dovjak, P. Choosing wisely in case of hypertension, diabetes and hyperlipidemia in older patients. Wien Med Wochenschr 166, 166–172 (2016). https://doi.org/10.1007/s10354-015-0426-x

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