A recent study suggests that clinical decision support (CDS) tools designed to curb unnecessary medical testing in older adults show lasting success in reducing urinary overtesting but fail to produce durable changes in prostate-specific antigen (PSA) screening practices. The findings were published online on Feb. 11 in the Annals of Internal Medicine.

Dr. Lucia C. Petito and colleagues from Northwestern University Feinberg School of Medicine conducted a study to evaluate the long-term effects of a behavioral intervention aimed at minimizing unnecessary testing and treatment in seniors. The study followed a pragmatic, cluster-randomized controlled trial across 60 primary care practices in Chicago, enrolling 371 clinicians. These clinicians were assigned either to receive a CDS intervention through an electronic health record system for 18 months or to a control group without the intervention.

The results showed that after the CDS intervention was discontinued, PSA testing rates among older men in the intervention group increased, while no such change was observed in the control group. In contrast, the intervention group exhibited a sustained reduction in urinalysis and urine culture testing compared to the control group, a trend that remained stable even after the intervention ended. For diabetes overtreatment, a slight reduction was noted in the intervention group at the start of the postintervention period, but by the end of the study, there was no significant difference between the groups.

The researchers concluded that CDS interventions aimed at reducing unnecessary care should either remain in place or be applied periodically to mitigate alert fatigue.

These findings suggest that to maintain benefits, CDS interventions should generally be left in place or be provided on a less frequent schedule,” the authors wrote.

The study underscores the need for continued refinement of CDS tools to ensure sustained effectiveness in reducing low-value medical care.