To improve the quality and cost-effectiveness of health care, the National Physicians Alliance compiled the top five practices in primary care that could be changed to raise the quality of services delivered and to make them more affordable.

Three top-five lists were detailed online ahead of print in Archives of Internal Medicine: one for family medicine, one for internal medicine, and one for pediatrics.

For family medicine practitioners: (1) no imaging for low-back pain within the first six weeks unless red flags are present; (2) no antibiotics for acute mild-to-moderate sinusitis unless symptoms last for seven or more days or symptoms worsen after initial clinical improvement; (3) no annual ECGs or any other cardiac screening for asymptomatic, low-risk patients; (4) no Pap tests on patients younger than age 21 years or in women after hysterectomy for benign disease; and (5) don’t use dual-energy x-ray absorpti­ometry screening for osteoporosis in women younger than age 65 years or men younger than age 70 years with no risk factors.

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In addition to the low-back pain imaging, cardiac screening, and osteoporosis screening directives, internal medicine practitioners are advised to avoid obtaining blood chemistry panels or urinalyses for screening in asymptomatic, healthy adults, and to use only generic statins when initiating lipid-lowering drug therapy.

Pediatricians should not prescribe antibiotics for pharyngitis unless the patient tests positive for Streptococcus; should not obtain diagnostic images for minor head injuries if the patient has not lost consciousness or has no other risk factors; should not refer otitis media with effusion early in the course of the problem; should advise patients against using cough and cold medicines; and should prescribe inhaled corticosteroids to control asthma appropriately.