Choosing Wisely Canada

Choosing Wisely Canada is a national campaign to help clinicians and patients engage in conversations about unnecessary tests and treatments, and make smart and effective care choices. Choosing Wisely Canada launched on April 2, 2014, and is organized by a small team from the University of Toronto, Canadian Medical Association and St. Michael’s Hospital.

It is part of a global movement that began in the United States in 2012, which now spans 20 countries across 5 continents. Choosing Wisely Canada inspires and engages health care professionals to take leadership on reducing unnecessary care, and enables them with simple tools and resources that make it easier to choose wisely.

Read Choosing Wisely Recommendations

Choosing Wisely Alberta

Choosing Wisely Alberta (CWA) started in 2014 and is a provincial campaign to reduce unnecessary care in the province of Alberta. CWA is organized by the Alberta Medical Association, in partnership with the Physician Learning Program, Alberta College of Family Physicians, Alberta Health, Alberta Health Services, Alberta Innovates Health Solutions, Institute of Health Economics, University of Alberta, University of Calgary, College of Physicians and Surgeons of Alberta and patients.

The current areas of focus for CWA are:

  • Healthy conversations supports for physicians and patients
  • Imaging for low back pain
  • Imaging for uncomplicated headaches
  • Imaging for minor head trauma
  • Red blood cell transfusions
  • Vitamin D testing
  • Bone density testing
  • Preoperative testing prior to low-risk surgeries
  • Appropriate use of antipsychotics
  • Cervical cancer screening
  • Pap smears
  • Among the change strategies being implemented are:
  • Physician education and champion support
  • Patient education and champion support
  • Audit and feedback
  • Process changes
  • Quality Improvement

To get involved, contact: choosingwisely@albertadoctors.org

August Update: Seniors Spotlight:The Canadian Geriatrics Society’s Five Things Physicians and Patients Should Question

https://choosingwiselycanada.org/geriatrics/

The Canadian Geriatrics Society, as part of the Choosing Wisely Canada campaign, reviewed and adopted the American Geriatrics Society’s Five Things Physicians and Patients Should Question. The recommendations include the following:

  1. Don’t use antimicrobials to treat bacteriuria in older adults unless specific urinary tract symptoms are present.
  2. Don’t use benzodiazepines or other sedative-hypnotics in older adults as first choice for insomnia, agitation or delirium.
  3. Don’t recommend percutaneous feeding tubes in patients with advanced dementia; instead offer oral feeding.
  4. Don’t use antipsychotics as first choice to treat behavioural and psychological symptoms of dementia.
  5. Avoid using medications known to cause hypoglycemia to achieve hemoglobin A1c <7.5% in many adults age 65 and older; moderate control is generally better.

For the full description, visit the Choosing Wisely Canada – Geriatrics page.

Reference:
Canadian Geriatrics Society. Five things physicians and patients should question. Ontario: Choosing Wisely Canada; [last updated: 2014 Apr 2; cited: 2017 Aug 11]; Available from: https://choosingwiselycanada.org/geriatrics/

June Update: Overuse in Obstetrics and Gynaecology

Under the leadership of the Society of Obstetricians and Gynaecologists of Canada, we are excited to announce the release of 10 new recommendations of tests, treatments or procedures that are overused in obstetrics and gynaecology:
Avoid the use of routine episiotomy in spontaneous vaginal births.

  • Don’t do electronic fetal monitoring for low risk women in labour; use intermittent auscultation.
  • Don’t perform routine urinalysis (protein, glucose) at every antenatal visit (in low risk normotensive women).
  • Don’t perform umbilical artery Doppler studies as a routine screening test in uncomplicated pregnancies with normal fetal growth.
  • Don’t use meperidine for labour analgesia due to its long-acting active metabolites and negative effects on neonatal behaviours.
  • Don’t routinely screen women with Pap smears if under 21 years of age or over 69 years of age.
  • Don’t routinely order hormone levels including estradiol, progesterone, follicle-stimulating hormone and luteinizing hormone in postmenopausal women or after a hysterectomy, either to diagnose menopause or to manage hormone therapy.
  • Don’t screen for ovarian cancer in asymptomatic women at average risk.
  • Don’t offer hysterectomy to women with asymptomatic fibroids on the basis of risk malignancy.
  • Don’t do any surgical intervention, including ablation, for abnormal uterine bleeding until medical management (including the progesterone intra-uterine system) has been offered and either declined or found unsuccessful.

See Obstetrics and Gynaecology: Ten Things Physicians and Patients Should Question to view the full list, including a rationale and references for each recommendation. This list will be available on our mobile app soon (Apple App Store / Google Play).