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Choosing Wisely goes global

There is considerable international interest in the Choosing Wisely campaign that focuses on potential overuse of medical tests and treatments, a recent report about a June 2014 meeting of representatives from 12 countries has shown.

The report – published in BMJ Quality & Safety – articulated five core principles for Choosing Wisely programs, and outlined some of the challenges faced by countries implementing the campaign.

Choosing Wisely started in the United States in 2012, with Choosing Wisely Canada following in 2014. Campaigns are now underway in Italy, the Netherlands and Switzerland, with similar programs planned in Australia, New Zealand, England, Germany, Japan and Wales. Denmark was also represented at last summer’s international gathering.

Key elements that should be present in any Choosing Wisely campaign were listed in the report, which was co-authored by Choosing Wisely Canada director Dr. Wendy Levinson, Dr. Sam Shortt, director of quality initiatives at the

Canadian Medical Association, and others. The report noted that those attending the international meeting agreed “the central goal of a Choosing Wisely campaign is to change the culture of medical care that has historically supported overuse of unnecessary tests, treatments and procedures.”

The report goes on to state that all representatives agreed the common factors contributing to this culture included “patient expectations, fears of missing a possible diagnosis or malpractice concerns, reimbursement incentives, the way physicians are taught, and avoiding the challenging conversation of telling patients they do not need specific tests or treatments.”

The authors stated: “A change from ‘more is better’ to ‘more is not always better’ in physician attitudes and behaviours” is a desired critical shift, as is significant engagement of patients and the public in any type of Choosing Wisely campaign.

As a result of discussions at the meeting, the authors developed five principles necessary for any Choosing Wisely campaign:

  • physician-led
  • patient-focused
  • evidence-based
  • multiprofessional
  • transparent

Challenges to successfully implementing any such program were also identified. These included misrepresenting campaign goals, failing to have specialty groups develop lists that include procedures performed by their own members and the complexity of measuring the impact of Choosing Wisely programs.

The authors concluded that the observed international uptake of the approach in a short time is encouraging, and that by stimulating conversations about the overuse of certain medical tests and treatments the campaign is proving successful in several countries.

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