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Choosing Wisely Canada targets more overused tests, treatments

Forty-nine new recommendations from 10 medical specialty societies have been released as part of the burgeoning Choosing Wisely Canada (CWC) campaign to encourage better communications between patients and physicians and avoid potentially unnecessary tests and treatments.

Two of the featured recommendations deal with avoiding computerized tomography (CT) scans for mild head injury and avoiding the use of psychostimulants for preschool children with attention deficit hyperactivity disorder (ADHD).

The release of these new recommendations brings the total to more than 150 CWC recommendations available to patients and physicians. Among that total are recommendations from 29 participating Canadian medical specialties.

“The recommendations released today target overused and unnecessary tests and treatments that physicians and patients should avoid in these circumstances,” said Dr. Wendy Levinson, chair of CWC. “Avoiding these tests and treatments when they are not needed will improve care and prevent possible side-effects.”

Canadian Medical Association President Chris Simpson noted: “The physician-patient relationship is based on communication, trust and the sharing of information to ensure the highest quality of care, and Choosing Wisely Canada is a critical tool for both sides of the examination table.”

The CWC recommendation concerning CT scans was developed by the Canadian Association of Emergency Physicians (CAEP) and recognizes that most adults and children with minor head injuries do not suffer from serious brain injuries requiring hospitalization or surgery. It was announced, with the others, at the recent CAEP annual conference in Edmonton.

Avoiding psychostimulants as the initial treatment for preschool children with ADHD recognizes the need to first assess children for environmental stressors such as neglect, abuse or exposure to domestic violence. The recommendation was developed through the collaborative effort of the Canadian Psychiatric Association, Canadian Academy of Child and Adolescent Psychiatry and the Canadian Academy of Geriatric Psychiatry.

Specialty associations releasing new recommendations included:

  • Canadian Academy of Child and Adolescent Psychiatry
  • Canadian Academy of Geriatric Psychiatry
  • Canadian Association of Emergency Physicians
  • Canadian Association of Nuclear Medicine
  • Canadian Association of Paediatric Surgeons
  • Canadian Psychiatric Association
  • Canadian Society for Transfusion Medicine (releasing five additional items)
  • Canadian Society for Vascular Surgery
  • Canadian Society of Hospital Medicine
  • Canadian Spine Society

The CMA is a lead partner in CWC, which focuses on linking best available medical evidence to both physicians and their patients and uses plain language and patient-friendly materials in its lists and resources.

Just prior to the release of the new recommendations, the New Brunswick Medical Society became the most recent provincial medical association to publicly announce its support for the CWC initiative, with a series of advertisements promoting the program.

The program – and the U.S. Choosing Wisely campaign upon which it is based – have been praised for succeeding in initiating conversations about eliminating low-value health care, most recently in a commentary published in the journal JAMA Internal Medicine.

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