Engaging physicians and patients in conversations about unnecessary tests and procedures: Choosing Wisely Canada

Levinson, Wendy; Huynh, Tai

doi:10.1503/cmaj.131674

Cited by 77 publications

(64 citation statements)

References 9 publications

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“…Typically list items are worded in this fashion—'Don't order imaging tests for patients with low back pain, unless red flags are present' (see online supplementary appendix A for a sample list). Modelled on the US initiative, Choosing Wisely Canada was launched in April 2014 and 21 societies have released lists to date 14. Italy adopted the principles of Choosing Wisely, incorporating them into a campaign called 'Doing more does not mean doing better', launched by ‘Slow Medicine’ (an independent organisation linked to the Slow Food movement), and the Netherlands recently launched the ‘Choosing Wisely Netherlands Campaign’.…”

Section: What Are Different Countries Doing?mentioning

confidence: 99%

‘Choosing Wisely’: a growing international campaign

Kallewaard²,

et al. 2014

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Much attention has been paid to the inappropriate underuse of tests and treatments but until recently little attention has focused on the overuse that does not add value for patients and may even cause harm. Choosing Wisely is a campaign to engage physicians and patients in conversations about unnecessary tests, treatments and procedures. The campaign began in the United States in 2012, in Canada in 2014 and now many countries around the world are adapting the campaign and implementing it. This article describes the present status of Choosing Wisely programs in 12 countries. It articulates key elements, a set of five principles, and describes the challenges countries face in the early phases of Choosing Wisely. These countries plan to continue collaboration including developing metrics to measure overuse.

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Section: What Are Different Countries Doing?mentioning

confidence: 99%

‘Choosing Wisely’: a growing international campaign

Kallewaard²,

et al. 2014

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“…2,3 Of interest for health policy makers, payers and clinicians are current utiliza tion rates for the procedures mentioned in these recommendations. Establishing baseline rates permits an understanding of the extent of the problem of lowvalue care, which in turn allows monitoring of the effect of initiatives such as Choosing Wisely on utilization rates over time.…”

mentioning

confidence: 99%

Preoperative testing before low-risk surgical procedures

Kirkham

Wijeysundera

Pendrith

et al. 2015

CMAJ

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) of procedures, respectively, whereas the rates of preoperative echocardiography and stress testing were 2.9% (95% CI 2.9%-2.9%) and 2.1% (95% CI 2.1%-2.1%), respectively. Significant variation was present across institutions, with the frequency of preoperative ECG ranging from 3.4% to 88.8%. Receipt of preoperative ECG and radiography were associated with older age (among patients 66-75 years of age, for ECG, adjusted odds ratio [OR] 18.3, 95% CI 17.6-19.0; for radiography, adjusted OR 2.9, 95% CI 2.8-3.0), preoperative anesthesia consultation (for ECG, adjusted OR 8.7, 95% CI 8.5-8.8; for radiography, adjusted OR 2.2, 95% CI 2.1-2.2) and preoperative medical consultation (for ECG, adjusted OR 6.8, 95% CI 6.7-6.9; for radiog raphy, adjusted OR 3.6, 95% CI 3.5-3.6). The median ORs for receipt of preoperative ECG and radiography were 2.3 and 1.6, respectively.Interpretation: Despite guideline recommendations to limit testing before low-risk surgical procedures, preoperative ECG and chest radiography were performed frequently. Significant variation across institutions remained after adjustment for patient-and institutionlevel factors. AbstractCMAJ Podcasts: author interview at soundcloud.com/cmajpodcasts/150174res

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“…Instead of advocating for an individual patient at all costs (thesis), as the resources are finite (antithesis), the concept of distributive justicesocially just allocation of goods in a society -allows for a meaningful allocation of resources for realistic outcomes, i.e., the best we can do for the patients given the resources we have so that other "individual" patients who are later in the queue can be appropriately cared for (synthesis). The recommendations in the relatively recent Choosing Wisely Canada initiative -endorsed by many national societies -allow for an evidence-based appropriate use of resources for diagnosis and management (Levinson and Huynh 2014). Physician leaders can become role models in their individual clinical practice and exhibit leadership by ensuring adoption of this framework throughout the organization, increasing the likelihood of attaining financial and quality-of-care goals.…”

Section: Discussion -Reconciling Dualitiesmentioning

confidence: 99%

Towards Reconciliation of Several Dualities in Physician Leadership

Saxena¹,

Walker²,

Kraines³

2015

hcpol

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Leadership has a renewed focus in healthcare, and physicians are being increasingly involved in a range of leadership roles. The aim of this paper is to discuss several dualities that exert tensions at the systems and individual levels. Although oppositional, the common dualities of physician leadership are not mutually exclusive but represent a complex, dynamic and interdependent relationship, often coexisting with each other and exerting tensions in multiple dimensions. The authors contend that a dialectic understanding -instead of either/or or finding a middle ground -of the opposite poles of these dualities allows for generating meaningful leadership perspectives and choices. RésuméLe leadership est au centre de l' attention dans les services de santé et les médecins s'impliquent de plus en plus dans une vaste gamme de rôles liés au leadership. L' objectif de cet article est d' aborder diverses dualités qui exercent des tensions aux niveaux des systèmes et des personnes. Bien qu' elles soient opposées, les dualités habituelles du leadership des médecins ne s' excluent pas l'une l' autre, mais représentent plutôt une relation d'interdépendance complexe et dynamique; elles coïncident souvent l'une avec l' autre et exercent des tensions sous plusieurs dimensions. Les auteurs affirment qu'une compréhension dialectique des pôles qui s' opposent dans ces dualités -plutôt que de choisir un des deux ou de trouver le juste milieu -permet d' obtenir un point de vue appréciable sur le leadership ainsi que sur les choix présents.

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Engaging physicians and patients in conversations about unnecessary tests and procedures: Choosing Wisely Canada

Cited by 77 publications

References 9 publications

‘Choosing Wisely’: a growing international campaign

‘Choosing Wisely’: a growing international campaign

Preoperative testing before low-risk surgical procedures

Towards Reconciliation of Several Dualities in Physician Leadership

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