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Physicians taking lead on appropriateness of care

Canada's doctors have taken bold measures to both define appropriate health care and implement an effective campaign to put it into action.

At the Canadian Medical Association (CMA) General Council meeting in Calgary Tuesday, delegates expressed concerns about attempts by governments to use discussions about the appropriateness of clinical care to delist medical services and implement cost savings.

"There is a real danger that some services will be delisted under the guise of providing appropriate care," said Newfoundland physician and former CMA president Dr. John Haggie.

"Appropriateness is about clinical care, not government accountability," he said.

"Best clinical decisions are at the heart of appropriate care, the goal to which our system should aspire," CMA President Dr. Anna Reid had stated earlier in the meeting.

A resolution brought forward by Haggie and adopted at the meeting defines appropriateness in health care as "the right care, provided by the right providers, to the right patient, in the right place, at the right time, resulting in optimal quality care."

In his rationale, Haggie noted that if all five components of the definition are present then high quality care will result - at the right cost.

Another resolution adopted at the meeting supported the development of data on health care delivery and patient outcomes, to help the medical profession develop an appropriateness framework and associated accountability standards.

Acceptance of this definition came following a presentation of the Choosing Wisely Canada campaign aimed at supporting physicians in helping their patients make the right choices about care - in other words, operationalizing appropriate care. At a more practical level, the initiative is a physician-led plan to identify certain common medical tests and procedures that are sometimes not used appropriately.

An overview of this successful campaign, adopted from the United States experience, was delivered by video from Toronto by Dr. Wendy Levinson, chair of Choosing Wisely Canada and professor of medicine at the University of Toronto.

Levinson said the challenge in talking about the overuse of medical tests or services with physicians is that it can be seen implying the rationing of services, rather than reducing waste and harm.

She said the success of the Choosing Wisely campaign in the US - which started with nine specialty groups and has now spread to 50 - is that it is physician-led but clearly aimed at helping patients.

In Canada, the CMA is currently working with seven medical specialty groups who are being asked to identify a list of 5-10 tests or procedures that are potentially overused or harmful.

Levinson said the aim is to launch the campaign in April 2014 with involvement of the public and patient groups.

The likely outcome of the campaign, she said, will be physician engagement in the proper use of finite resources, a public awareness of why 'more is not better' and a decrease in the use of tests and treatments where they are not needed.

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