e-Panel Survey Summary
Choosing Wisely Canada
The CMA asked e-Panel members questions related to the organization’s support of the Choosing Wisely Canada (CWC) campaign. CWC is a campaign to help clinicians and patients engage in conversations about unnecessary tests, treatments and procedures. The results provide a picture of panelists’ opinion and awareness of the campaign, their use of the various CWC resources, and their opinion on the effectiveness of the resources. A summary of the results of the e-Panel survey is presented below.
Survey – November 2016
The survey was sent to 3,864 e-Panel members (mainly targeted to medical students, medical residents, and practicing physicians). 803 responded, for a completion rate of 20.8%.
Awareness of the campaign & CMA involvement
88.4% of survey respondents (n=710) were aware of the CWC campaign. If respondents indicated awareness, they were asked if they were aware of the CMA’s role as a leading partner in the campaign. 77.3% of these 710 respondents were aware of this fact.
Use of CWC lists and resources
Respondents who are practising were asked if they used the CWC lists in their daily clinical practice. 48.4% of respondents indicated that they did not use the CWC lists compared to 42.4% of respondents who did. 9.3% responded that the question was not applicable.
When respondents did use CWC lists, they were asked about their frequency of using those lists. Of the 42% of respondents (n=284) who reported using CWC lists, 48.2% of respondents said that they used the lists occasionally, while 31.0% reported frequent usage and 15.5% very frequent usage of the lists. Of the respondents who reported using the lists, only 5.3% indicated rare usage.
66.0% of respondents strongly disagreed (20.2%) or disagreed (45.8%) that their patients had sufficient tools and/or information to make informed decisions about appropriate use of services. On the physician perspective, 47.7% of respondents strongly agreed (9.0%) or agreed (38.7%) that they as physicians needed more support and/or tools to help make decisions about which services were inappropriate for their patients.
Effectiveness of the CWC campaign
When asked if the CWC campaign has been effective in reducing unnecessary use of health care services, a majority of respondents (52.0%) were unsure. About 30% of respondents strongly agreed (2.4%) or agreed (27.6%) that the campaign was effective in achieving this goal. In contrast, 18.1% of respondents disagreed (16.4%) or strongly disagreed (1.6%) with the notion that the campaign was effective in this sense.
We asked e-Panel members what types of tools/resources would help them implement the CWC recommendations in their practice. Some of the suggestions they provided included:
- Administer penalty/incentive program for physicians to follow recommendations
- Increased public awareness & education: pamphlets/handouts, posters in clinics and ER rooms, pediatric resources/pamphlets
- Wide patient/media education campaign
- Mobile app with resources organized by disease/specialty/symptoms (separate for physicians and patients)
- More sharable electronic content (apps, tools, programs, PDFs)
- Evidence-based reasoning behind the recommendations
- CME-credits and/or Royal College requirements; endorsement from provincial colleges/PTMAs
- EMR-specific tools: custom forms, stamps, reminders, recommendations
- Simplify guidelines/criteria for ordering medical tests – more accessible for physicians & patients, more understandable for patients
- Specify certain tests with asterisks to indicate CWC recommendations associated/key indications to qualify ordering a medical test
As a founding partner of CWC, the CMA will continue to seek opportunities to promote awareness of the goals and objectives of the campaign, including patient and physician tools (lists) to promote appropriate use of tests, treatments and procedures.
Respondents told us
“A good campaign but patients need much more education, and this should be done outside of the physician's office.”
“It's about educating patients more so than physicians. Many demand specific tests, when there is absolutely no need for it. Spending time and educating them occasionally, especially in those with anxiety and those less educated, has no effect.”
“I think it is too early to measure the impact of CWC. I think that patient information (such as posters and handouts/brochures) should be more prominently distributed. This would be a useful way for the CMA to contribute and, also, increase the CMA's visibility.”
“Physicians are extremely reluctant to tell their patients some imaging isn't indicated for both patient peace of mind and fear of litigation. That has to be addressed.”
“I know about the initiative but not the tools or recommendations. More guidance on a) where they are located and b) how to use them would be helpful.”
“Has Choosing Wisely been proven to exert a positive impact? For example, it sets out to reduce costs/inefficient test usage.... Has this been proven to work?”
“I like it, but am tired of feeling like the target being blamed for overuse. Yes we are the gatekeepers, but we are also at the mercy of patient ‘satisfaction' and college threats if patients feel we aren't doing everything they want.”