Choosing Wisely Australia® launches today—kick-starting a national conversation about more appropriate health care. In a first for Australia, medical colleges and societies have united to take the lead on identifying those tests, treatments and procedures they think are of proven low value or carry an unnecessary risk.
Among the lists are recommendations on food allergy testing, prostate cancer screening, vitamin D screening, monitoring of type 2 diabetes, benzodiazepine prescribing, emergency medicine procedures and ankle and spine imaging.
The initiative is health profession-led and is facilitated by NPS MedicineWise. The national medical societies and colleges releasing recommendations today are the Australasian College for Emergency Medicine, the Australasian Society of Clinical Immunology and Allergy, The Royal Australian College of General Practitioners, The Royal Australian and New Zealand College of Radiologists and The Royal College of Pathologists of Australasia.
Imaging for low back pain? Think again
The ordering of diagnostic imaging for patients with non-specific acute low back pain is listed as a test to question. "Low back pain is the third most common health complaint seen by Australian general practitioners. Imaging for acute low back pain is one of the tests to feature on our list—it is not recommended for patients with non-specific low back pain, the majority of these patients," says Dr Gregory Slater from the Royal Australian and New Zealand College of Radiologists (RANZCR).
"Imaging is only indicated initially if the patient has indicators of a serious spinal condition, spinal canal stenosis or sciatica. Implementing this recommendation on lower back pain, as well as our other Choosing Wisely Australia recommendations on imaging will result in improved imaging access to appropriate and quality tests and better patient care."
Treatment for heartburn and reflux? Question long-term use
Long-term use of one of Australia's most prescribed medicines, called proton pump inhibitors (PPIs) which are used to treat stomach acid and reflux, is also listed as a treatment to question. Last financial year the cost of anti-acid medication was $450 million, with prescription volume increasing 9% annually.
"One of our 'top 5' items is to not prescribe these medicines long term in patients with uncomplicated disease whose symptoms are well-controlled without regular attempts at reducing dose or ceasing. The treatment is on the RACGP Choosing Wisely list because unnecessary long term use can potentially lead to adverse effects alongside a significant cost to both patients and the health system," says Dr Frank R Jones, President of the Royal Australian College of General Practitioners (RACGP).
Stimulating informed conversations
"The launch of Choosing Wisely Australia will stimulate informed conversations about the right care, with the ultimate goal to ensure delivery of high-quality healthcare for Australians by reducing inappropriate care. The initiative challenges the notion that more is always better when it comes to healthcare. Australians can use their voice and ask what the risks are of a test, treatment or procedure," says NPS MedicineWise CEO Dr Lynn Weekes.
"NPS MedicineWise is proud to be facilitating Choosing Wisely in Australia, and I congratulate the five inaugural colleges and societies involved in this initiative for releasing their evidence-based recommendations today and sharing them with Australian health professionals and consumers. These lists are just the beginning of a national conversation about appropriate healthcare."
Choosing Wisely Australia will continue as a new voice in Australian healthcare as other medical colleges and societies come on board and release their own lists. Several are already lined up to release theirs before the end of 2015.
Choosing Wisely Australia is modelled after the successful Choosing Wisely campaign in the United States, launched in 2012 by the American Board of Internal Medicine's ABIM Foundation.
Clear, evidence-based and straightforward materials have been developed for both consumers and health professionals to support better decisions. These are available on the Choosing Wisely Australia website launching today at www.choosingwisely.org.au
Full copies of the "5 things clinicians and consumers should question" from each participating medical college and society are now available on the official website.
Media are invited to attend the official launch of Choosing Wisely Australia at 10:00am on 29 April 2015 at NPS MedicineWise, Level 7, 418A Elizabeth Street, Surry Hills.
NPS MedicineWise media enquiries: Elisabeth Bowdler on (02) 8217 8667, 0419 618 365 or firstname.lastname@example.org
ACEM media enquiries: Nat Tunbridge on 0420 325 934 or Nat.Tunbridge@acem.org.au
ASCIA media enquiries: Kathryn McFarlane, Royal Australian College of Physicians on (02) 9256 9658, 0419 850 201 or Kathryn.McFarlane@racp.edu.au
RACGP media enquiries: Alexandra Hooper on (03) 8699 0442 or email@example.com
RANZCR media enquiries: Kate Scott-Murphy on (02) 9268 9734, 0404 203 733 or Kate.Scott-Murphy@ranzcr.edu.au
RCPA media enquiries: Georgy Searles, S2i Communications on (02) 9262 4766, 0417 764 587 or Georgy@s2i.com.au
A video news release with B roll of general medical images including pathology and imaging is also available.
Join the conversation on twitter @ChooseWiselyAU
ADDITIONAL QUOTES FROM MEDICAL COLLEGES AND SOCIETIES
The Australasian College for Emergency Medicine (ACEM)
"My colleagues in emergency care apply the principles of Choosing Wisely Australia in their day-to-day work. It's a reality that emergency departments continually have high demand for their services and are always running at capacity. Thus, we must always focus on the appropriateness of what we are doing—making sure that what we do is right for the individual patient while at the same time ensuring equitable distribution of resources for all patients.
"Choosing Wisely Australia is extremely important in addressing this across the whole healthcare system. It is a very good way of equipping consumers to ask the right questions. Better-informed consumers can hold their caregivers to account—by this I mean have the information they need to make decisions about the options being offered. It can be difficult for people in stressful situations to choose between one option and another", said Dr Sally McCarthy, immediate past president of the Australasian College for Emergency Medicine.
Australasian Society of Clinical Immunology and Allergy (ASCIA)
"My colleagues in the Australasian Society of Clinical Immunology and Allergy (ASCIA) have been concerned for some time that in the area of allergy and immunology there are tests and treatments where there is little or no evidence to support them. We believe that it is the right of every consumer to have the benefits of the highest standard of care and to be fully informed of the scientific evidence behind the testing or treatments they undergo.
We are very excited about Choosing Wisely Australia because it is one of the first initiatives of its kind to have strong consumer engagement. It gives us the ability to inform consumers. Educated consumers who make informed choices make our job a great deal easier," said Dr David Gillis of the Australasian Society of Clinical Immunology and Allergy.
Royal Australian College of General Practitioners (RACGP)
"GPs are on the front line of patient care and it is with good reason we are often called 'the gatekeepers' of care," Royal Australian College of General Practitioners (RACGP) President Dr Frank R Jones said. "GPs care for the whole patient and more than any other area of medical practice; we have the opportunity to develop long-term relationships with our patients. This means we are well placed to help our patients make appropriate choices.
"We believe Choosing Wisely Australia, with its recommendations based on best evidence, will play an essential role in helping GPs engage in conversations with their patients about the right care. The RACGP is very pleased and proud to be one of the medical colleges leading this important initiative."
Royal Australian and New Zealand College of Radiologists (RANZCR)
"We're delighted to be involved from the outset of the Choosing Wisely Australia initiative because it allows us to build on our work on inappropriate imaging," said Dr Greg Slater, Dean, Faculty of Clinical Radiology, The Royal Australian and New Zealand College of Radiologists. "Medical imaging is central to our health system, allowing us to diagnose and treat patients with more accuracy than ever before.
"We need to make sure that medical imaging is always appropriate and clinically accountable. Choosing Wisely provides a great opportunity for radiologists to discuss appropriate imaging with referring doctors and patients."
The Royal College of Pathologists of Australasia (RCPA)
"As the leading medical body for pathologists and scientists in Australasia, The Royal College of Pathologists of Australasia (RCPA) is dedicated to training and supporting pathologists, and improving the use of pathology testing to maintain the highest standards for the benefit of patients and clinicians," says A/Prof Peter Stewart, President of the RCPA.
"The RCPA works to identify the Medicare Benefits Schedule (MBS) listed pathology tests that are outmoded or requested inappropriately. Our goal is to ensure that the MBS reflects contemporary medical practice. By partnering with Choosing Wisely Australia, we have the opportunity to refresh the schedule by potentially removing a number of low value tests and adding those tests which have been proven to be more appropriate."
"From a patient perspective, we are also very supportive of the initiative's engagement with consumers. As an increased number of patients have direct access to their pathology results, the support of sound, evidence-based information is crucial for patients to interpret and understand these results."
The Royal Australasian College of Physicians (RACP)
"As a college, we believe Choosing Wisely Australia is going to be critically important in improving and strengthening the quality of care across the health system," said Laureate Professor Nicholas Talley, President of the Royal Australasian College of Physicians.
"This initiative recognises that medical practice is dynamic – continually evolving and improving all the time, based on evidence and experience. Choosing Wisely is part of a movement to change the culture of medical practice and I think the timing is right and the environment is right to start this change. The end result will be a more patient centred healthcare system, providing high-quality care aligned with the latest evidence."
Consumers Health Forum (CHF)
Choosing Wisely Australia is a great advance for health consumers, says the CEO of Consumers Health Forum, Ms Leanne Wells. "It offers the prospect of in-built and continuing improvement in medical treatment while also fostering the practice of consumer-centred care. And it has the much wider benefit to our health system of discouraging the use of outmoded or poorly-based treatments, reducing wasteful expenditure and encouraging cost-effective health care. CHF has argued in support of evidence-based, cost-effective care in Australia so that the health dollar does go further and reduces the demand for cuts to the health budget.
"As importantly, Choosing Wisely exposes health care to the sort of scrutiny which has too often been absent in the past. This enables consumers to have a more active role in their treatment choices --- a development which research is showing improves outcomes, reduces costs and leaves both patient and clinician more satisfied."
Find a copy of the media release here: http://www.nps.org.au/media-centre/media-releases/repository/australia-joins-the-global-choosing-wisely-healthcare-revolution