Dr Matthew Anstey MBBS MPH FACEM FCICM PGDipEcho DCH Choosing - - PowerPoint PPT Presentation

Dr Matthew Anstey

MBBS MPH FACEM FCICM PGDipEcho DCH Choosing Wisely Australia Advisory Board Member Medical Advisor to Australian Commission on Safety and Quality in Health Care Intensive Care Physician Sir Charles Gairdner Hospital August 2015

CHOOSING WISELY AUSTRALIA

• Starting a national conversation about tests,

treatments and procedures that provide no benefit and in some cases may cause harm

• Focused on high quality care, supporting

conversations between the consumer and clinician

• Based on the best available evidence and what

care is truly needed

• Part of a global movement to assess low value

care

Do you agree?

• There is a problem with the use of

unnecessary tests, treatments and procedures in medical practice.

– Strongly agree – Agree – Neutral – Disagree – Strongly disagree

• In your own practice, how often do patients

ask for a test, treatment or procedure that you think is unnecessary?

• Every day
• Several times a week
• Once a week
• Less than once a week
• Less than once a month

Do you agree?

• Medical practitioners have a responsibility to

help decide on the appropriate use of tests, treatments and procedures?

– Strongly agree – Agree – Neutral – Disagree – Strongly disagree

• How much influence do you have in reducing

the use of unnecessary tests, treatments and procedures in your clinic or service?

– A high level of influence – A moderate level of influence – Some influence – Limited influence – No influence

THE ISSUES

• Not all tests add value
• Can expose the consumer to

undue risk of harm and cost

• Consumers are often

unaware

• Many tests have become

ingrained in the system

THE ISSUES

• Consumer expectations:

‘more is better’

• Pressure on clinicians to

cover all clinical possibilities

• 30% expenditure in the US

considered wasteful*

*reference available on request

Choosing Wisely – United States

• Began in 2009 from ABIM
• Physician charter for professionalism includes:

“commitment to a just distribution of finite resources”

• Top Five lists – speciality specific enumerations of five

achievable practice changes to improve patient health through better treatment choices, reduced risks, and, where possible, reduced costs.

• >50 speciality-specific lists and more than 10

consumer partners

• Preserves the pre-eminence of physician judgement,

patient choice and therapeutic relationship

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CHOOSING WISELY AUSTRALIA

• Led by Australia’s

medical colleges and societies

• Facilitated by NPS

MedicineWise

• Colleges and

societies develop lists of recommendations

CHOOSING WISELY LAUNCH

Five medical colleges and societies released their recommendations, “5 Things to Question”

LIST DEVELOPMENT

• Lists and recommendations are developed and
• wned by the colleges and societies
• List development criteria:

– Tests and treatments misused or over used

• r carry significant cost

– Items within the speciality's purview and control – Evidence based – Transparent process

Choosing Wisely Australia

• RACGP: long term PPI use, don’t

HT/lipids therapy without assessing risk, don’t self monitor type 2 DM oral, don’t screen low risk CV patients, avoid BDZ with history misuse/multiple agents.

• ACEM
• RCPA : urine cultures, PSA testing

& hyperlipidaemia < 7yrs of life, Vitamin D, tumour markers

• RANZCR: imaging for ankles,

lower spine & cervical spine; duplex ultrasound, PE

• Australasian Society Clinical

Immunology and Allergy

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Australasian College for Emergency Medicine

• Avoid requesting CT KUB in otherwise healthy emergency

department patients, age <50, with known history of kidney stones, presenting with symptoms and signs consistent with uncomplicated renal colic.

• Avoid coagulation studies in emergency department patients

unless there is a clearly defined specific clinical indication, such as for monitoring of anticoagulants, in patients with suspected severe liver disease, coagulopathy or snakebite.

• Avoid blood cultures in patients who are not systemically septic,

have a clear source of infection and in whom a direct specimen for culture is possible.

ACEM

• For emergency department patients approaching end-
• f-life, ensure clinicians, patients and families have a

common understanding of the goals of care.

• Don’t request imaging of the cervical spine in trauma

patients, unless indicated by a validated clinical decision rule, such as Canadian C Spine rule or Nexus Low risk criteria.

• Don’t request CT head scans in patients with a head

injury, unless indicated by a validated clinical decision rule,

REACHING CONSUMERS

• Supporting both

consumers and clinicians to have conversations about appropriate care

• Consumer resources

for website

• Engaging with

consumer

• rganisations

MEDIA COVERAGE

• ‘Campaign urges patients,

doctors to cut unnecessary tests and treatments’ ABC News Online

• ‘Less is the New More:

Choosing medical tests and treatments wisely’ The Conversation

• ‘Unnecessary tests: Choosing

Wisely campaign targets brain scans, food allergy tests’

Sydney Morning Herald

CRITICAL SUCCESS FACTORS

• Health profession-led, collaborative approach
• Consumers at the centre
• List development and ownership driven by

colleges

• Talking to patients : ‘Quality’, ‘reducing risk of

harm’ and ‘waste’ resonates

• Implementation and evaluation