Croakey - Choosing Wisely in Australia: broadening the conversation to reduce low-value healthcare

Australia’s Choosing Wisely initiative, spearheaded by NPS MedicineWise, is now in its third year. A new report from Choosing Wisely, released today, is both a celebration of the movement’s progress to date and an invitation to join the ongoing conversation between health professionals and patients about which tests, treatments and procedures are likely to be harmful or of low value.

Below, Dr Lynn Weekes AM, Chief Executive of NPS MedicineWise, outlines some highlights from the report, and flags the challenges and opportunities up ahead.

Dr Weekes writes:
The international Choosing Wisely initiative, launched in Australia by NPS MedicineWise in April 2015, has been recognised by the Organisation for Economic Co-operation and Development (OECD) as one approach with significant potential to address low-value healthcare.

Recognising that the drivers of unnecessary healthcare are complex and varied, the OECD report states that sustainable change is achievable if patients and clinicians are persuaded the better option is the less harmful or least wasteful one.

This is what Choosing Wisely seeks to achieve – a sustainable solution to unnecessary healthcare, led by the health profession. Specifically, it encourages conversations between patients and health professionals about what tests, treatments and procedures are truly needed.

Productive conversations
Today NPS MedicineWise is releasing its latest report on Choosing Wisely Australia, Join the conversation, which recognises the increasing adoption of Choosing Wisely as a catalyst for reducing low-value healthcare in this country. It also highlights the significant results being achieved through the implementation activities of our members and supporters.

Now in its third year, Choosing Wisely Australia is maturing as a national social movement. Since its launch, membership has grown to 51 organisations, including 37 health professional colleges, societies and associations and 12 health services.

There have been 158 evidence-based recommendations about healthcare practices to question, released by the initiative to date. This year, new recommendations were released for the use of imaging to diagnose bronchiolitis and asthma in children, administering anaesthetics to people aged over 70, and taking antibiotics and other medications when they’re not needed.

Getting the message out
These recommendations are disseminated to healthcare professionals and the public through a variety of channels, such as college member communications, training modules, annual scientific meetings, websites and media campaigns.

In 2017, NPS MedicineWise incorporated Choosing Wisely Australia recommendations into one of its national educational visiting programs for general practitioners (GPs). The aim is to reduce inappropriate referrals for ultrasound and X-ray for acute ankle and knee injuries, and MRI for acute knee injuries.

A full evaluation of the program is underway, but early survey results show:

• GPs who participated in an educational visit reported changed behaviour in line with Choosing Wisely recommendations
• 14% of GPs surveyed intended to change their practice around imaging referrals
• 40% of GPs surveyed said they had already changed practice
• participant GPs were more aware of both the Ottawa ankle and the Ottawa knee rules, with 81% aware of the ankle rules (31% control) and 73% aware of the knee rules (52% control).

Tracking success, questioning assumptions
Another first for Choosing Wisely Australia was our May National Meeting. The event attracted more than 250 delegates – a broad cross-section of stakeholders – and results from the first Choosing Wisely projects implemented in hospitals were released. This included projects to reduce unnecessary pathology tests, and to support deprescribing of medicines such as proton pump inhibitors.

Our 2017 Report includes the results of an annual Choosing Wisely Australia survey of GPs and specialists and shows awareness of the initiative is growing: GPs 59% (up from 54% in 2015) and specialists 49% (up from 37%).

GPs (85%) and specialists (89%) largely agreed there was a problem with the use of unnecessary tests, treatments and procedures in medical practice, and around half of both GPs and specialists agreed they had a responsibility to help reduce inappropriate healthcare interventions.

The top drivers of unnecessary tests, treatments and procedures remained patient expectation, fear of litigation, diagnostic uncertainty and difficulty accessing information and results from clinicians in other settings.

While it’s encouraging to see awareness of Choosing Wisely Australia growing among the health profession, it’s clear there remains a disconnect about what drives rates of unnecessary tests.

Our national consumer survey showed 84% of respondents said their healthcare provider recommended tests, with only 14% saying they asked for a test. The consumer survey also showed only 28% of people agreed having an unnecessary medical test could be harmful to their health.

When asked about their role in reducing unnecessary healthcare, 61% believed they had a role to play in reducing the use of unnecessary tests.

Seizing opportunities
Recognising the need for greater consumer awareness of the risks associated with unnecessary healthcare, Choosing Wisely Australia and the Consumers Health Forum of Australia have embarked on a joint project to engage the broader community in the initiative.

Working with GPs, representatives of Primary Health Networks and consumer advocates, the project aims to grow awareness of and engagement in the initiative, and to foster environments where people are confident to ask questions regarding the necessity, risk and costs associated with recommendations to manage their health.

There is certainly plenty of opportunity ahead for Choosing Wisely in Australia.