The Italian Society of Internal Medicine choosing wisely campaign

Abstract

Appropriateness is one of the critical aspects of medicine. For this reason, the Italian Society of Internal Medicine (SIMI) decided to adhere to the Choosing Wisely Campaign. A bottom-up approach was chosen. All the recommendations published in the US and Canadian Choosing Wisely campaign have been screened, and an e-mail was sent to all the SIMI members for new suggestions. The thirty interventions that were judged as the highest priority by a committee were sent to all the SIMI members for voting. The first procedures selected were then revised, and constituted the five points of the SIMI choosing wisely campaign. The identified procedures were: (1) avoid prescribing bed rest unless an acceptable indication exists. Promote early mobilization; (2) Do not perform a D-dimer test without a precise indication; (3) Do not prescribe long term intravenous antibiotic therapy in the absence of symptoms; (4) Do not indefinitely prescribe proton pump inhibitors in the absence of specific indications; (5) Do not place, or leave in place, peripherally inserted central catheters for patient's or provider's convenience. Four of these points were not present in any other campaign, while one, the fifth, was already present. The bottom-up approach of the SIMI "Choosing Wisely" campaign favored the identification of different priorities compared to other campaigns. Future studies should now evaluate if the application of these "not-to-do" recommendations will be associated with an improvement of clinical outcome and a subsequent direct and indirect health care cost reduction.

SOBRINA Spanish study—analysing the frequency, cost and adverse events associated with overuse in primary care: protocol for a retrospective cohort study

“…In several countries, frequency estimations have been followed up by information campaigns43–49 targeting clinicians and, in some cases, patients, to reduce this overuse. Despite their modest results, they seem to point in the right direction although greater engagement by all stakeholders involved is necessary to achieve better results 50…”

The Romanian Society of Internal Medicine’s Choosing Wisely Campaign

“…This recommendation was issued by the Society of Hospital Pharmacists of Australia [5]. Similar recommendations were endorsed by the Italian Society of Internal Medicine [7] and the Society for Healthcare Epidemiology of America [3]. Other Choosing Wisely recommendations targeting inappropriate use of antibiotics referred to treating asymptomatic bacteriuria only in pregnancy or in patients undergoing endoscopic urological procedures [3,4,9], not indicating antibiotics for uncomplicated upper respiratory tract infection [3,4,9], uncomplicated sinusitis [3] or bronchitis [3,4].…”

“…In March 2017 two members of the Working Group performed a literature search, accessed and collected all Choosing Wisely lists published until then from the Internal Medicine and related subspecialties' societies in the United States [3], Canada [4], Australia [5], United Kingdom [6], the Italian Society of Internal Medicine [7], the Italian Federation of Associations of Hospital Doctors in Internal Medicine [8] and the Swiss Society of General Internal Medicine [9]. Recommendations from Surgery and related subspecialties, Pediatrics, Imaging and Radiology, Genetics, Ophthalmology, Dermatology and Dentistry Societies were not collected.…”

“…Adopting the methodology proposed by the Italian Society of Internal Medicine [7], we set out to involve all members of our society, giving them the chance to vote for the recommendations acknowledged as most important. Compared to other societies' methodologies, where a group of opinion leaders chose the final recommendations, we considered this strategy to have a higher chance of long-term success in our country.…”

“…The Italian Society of Internal Medicine [7] issued the same recommendation, as did The American Academy of Nursing [3] and the Canadian Association of Physical Medicine and Rehabilitation [4]. More so, the American Academy of Physical Medicine and Rehabilitation [3] and the North American Spine Society [3] recommend caution and proper assessment of the indication of prolonged bed rest for back pain, while the American Physical Therapy Association [3] recommends bed rest after initiation of anticoagulant therapy for diagnosis of deep vein thrombosis only if significant medical concerns are present.…”