{
  "abstract": "Objectives A proactive treatment paradigm has been established for people with chronic conditions: rather than waiting for symptoms to appear, patients visit a practice for regular check-ups (= monitoring). However, diagnostic findings may lead to concerns and create uncertainty on the side of patients and physicians, which in turn can lead to further examinations (so-called diagnostic cascades). Our project aimed to describe the frequency of specific monitoring procedures, to explore the physicians’ underlying motives and to understand patients’ perceptions. Furthermore, we aimed to identify recommendations on monitoring in clinical guidelines.Method Two regularly performed ultrasound routines in Germany (‘echocardiography in coronary heart disease (CHD)’ and ‘carotid duplex ultrasound after stroke’) which weren’t mentioned by relevant guidelines have been analysed using a mixed-method design. The percentage of patients receiving these monitoring routines as well as the frequency and differences compared with unmonitored patients were analysed using German health insurance data from 2015 until 2019 (2021). Motives were explored in an interview study with patients, GPs and specialists working in outpatient care. Furthermore, national and international guidelines of ten chronic conditions have been assessed with regard to recommendations on monitoring.Results Around 7% of patients who had a stroke underwent regular monitoring using carotid ultrasound, and 15% patients with CHD were regularly examined using echocardiography. The examinations mainly took place at specialist practices, but not at general practitioners. In the interviews, patients highlighted that monitoring gave them a sense of security and that they trusted their doctor’s recommendations on this. Physicians mentioned that monitoring became a habit (and was then rarely questioned). Financial incentives also seemed to determine whether and how often monitoring is carried out. Most guideline recommendations provided sufficient information on parameters, but not on consequences of monitoring. Only one-third of the recommendations made specific statements regarding the frequency of the monitoring dates. For many recommendations, no evidence could be identified or level of evidence was very low or low. Recommendations often advised doing a measure, do-not-do recommendations have been found rarely.Conclusions Monitoring chronic conditions is important to detect disease progression or side effects of therapies. However, a lack of or insufficient evidence and emotional aspects as important drivers also contribute to inappropriate tests and procedures and carry the risk of overtesting and overdiagnosis.",
  "authors": [
    {
      "affiliations": [
        "FAU Erlangen-Nürnberg",
        "Institute of General Practice, Erlangen, Germany"
      ],
      "name": "Susann Hueber"
    },
    {
      "affiliations": [
        "FAU Erlangen-Nürnberg",
        "Institute of General Practice, Erlangen, Germany"
      ],
      "name": "Thomas Kühlein"
    },
    {
      "affiliations": [
        "FAU Erlangen-Nürnberg",
        "Institute of General Practice, Erlangen, Germany"
      ],
      "name": "Lisette Warkentin"
    },
    {
      "affiliations": [
        "FAU Erlangen-Nürnberg",
        "Institute of General Practice, Erlangen, Germany"
      ],
      "name": "Laura Rink"
    },
    {
      "affiliations": [
        "FAU Erlangen-Nürnberg",
        "Institute of General Practice, Erlangen, Germany"
      ],
      "name": "Ciara Elisa Fink"
    },
    {
      "affiliations": [
        "FAU Erlangen-Nürnberg",
        "Institute of General Practice, Erlangen, Germany"
      ],
      "name": "Victoria Koschemann"
    },
    {
      "affiliations": [
        "FAU Erlangen-Nürnberg",
        "Institute of General Practice, Erlangen, Germany"
      ],
      "name": "Felix Werner"
    },
    {
      "affiliations": [
        "FAU Erlangen-Nürnberg",
        "Institute of General Practice, Erlangen, Germany"
      ],
      "name": "Jennifer Scheel-Barteit"
    },
    {
      "affiliations": [
        "FAU Erlangen-Nürnberg, Erlangen, Germany"
      ],
      "name": "Werner Adler"
    },
    {
      "affiliations": [
        "Philipps-Universität Marburg, Institute of General Practice, Marburg, Germany"
      ],
      "name": "Lydia König"
    },
    {
      "affiliations": [
        "Philipps-Universität Marburg, Institute of General Practice, Marburg, Germany"
      ],
      "name": "Konrad Hierasimowicz"
    },
    {
      "affiliations": [
        "Philipps-Universität Marburg, Institute of General Practice, Marburg, Germany"
      ],
      "name": "Julia Heisig"
    },
    {
      "affiliations": [
        "Philipps-Universität Marburg, Institute of General Practice, Marburg, Germany"
      ],
      "name": "Veronika van der Wardt"
    },
    {
      "affiliations": [
        "Philipps-Universität Marburg, Institute of General Practice, Marburg, Germany"
      ],
      "name": "Carolin Gonschorek"
    },
    {
      "affiliations": [
        "Philipps-Universität Marburg, Institute of General Practice, Marburg, Germany"
      ],
      "name": "Annika Viniol"
    }
  ],
  "title": "087 Risk of overtesting and overdiagnosis in the monitoring of chronic conditions. Results of a mixed-method study in Germany",
  "uid": "a2affd81-619c-53ec-9e71-3ab4d58f6cb3"
}