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Kia āta kōwhiri Choosing Wisely

The Choosing Wisely campaign seeks to reduce harm from unnecessary and low-value tests and treatment.

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Many Choosing Wisely recommendations relevant to general practice

Choosing Wisely Te Tāhū Hauora Health Quality & Safety Commission
18 May 2018

There are many Choosing Wisely recommendations that are relevant to GPs, says Royal New Zealand College of General Practitioners’ medical director, Dr Richard Medlicott.

The Choosing Wisely campaign encourages health professionals to talk with patients about unnecessary tests, treatments and procedures; and patients to discuss with their health professional whether they really need a particular intervention.

The Health Quality & Safety Commission is a partner in the Council of Medical College’s Choosing Wisely campaign. The campaign encourages health professionals to question current practice and to talk to patients about the potential risks and benefits of undergoing tests, treatments and procedures.

Dr Medlicott says the College supports the campaign but decided against having its own list of recommendations.

'GPs are generalists. When we looked at the recommendations from other colleges and societies, we decided that there are many which are worthwhile for the College to keep an eye on.

'Rather than create our own list, we think it’s more beneficial to spread the message to GPs that we endorse the campaign and that GPs are in an excellent position to choose wisely.'

For some months, a Choosing Wisely ‘tip of the week’ – or several related recommendations – have been published in ePulse, the College’s weekly electronic newsletter. The three topics that have attracted the most ‘clicks’ which take readers to the detail of the recommendation on the Choosing Wisely website are:

  1. Avoid prescribing antibiotics for upper respiratory tract infection.
  2. Avoid requesting CT imaging of kidneys, ureters and bladder in otherwise healthy emergency department patients.
  3. Do not prescribe benzodiazepines or other sedative-hypnotics to older adults as first choice for insomnia, agitation or delirium.

'We can take the recommendations a bit further when promoting them to our members,' says Dr Medlicott. 'GPs do a lot of prescribing, especially of antibiotics, and we also prescribe to older people with comorbidities, which raises the issue of polypharmacy in the elderly.

'We know that the longer a GP spends in a consultation, the less likely they are to prescribe antibiotics – or any medication – so that raises issues such as access to care, workloads, and so on.

'GPs are quite resource constrained. It’s difficult for a GP to order CT scans, let alone MRI scans. But, it’s helpful to know what the Choosing Wisely recommendations are so we can have better conversations with our patients about the evidence for doing or not doing a particular procedure.

'For example, an orthopaedic surgeon may recommend arthroscopy and removal of cartilage in an arthritic knee. However, the evidence is that this procedure makes no difference to the patient.'

Dr Medlicott says all the Choosing Wisely messages are worthwhile and many are particularly relevant to general practice.

'Unnecessary prescribing – particularly of antibiotics – is an area that we need to focus on. We don’t want to encourage the post-antibiotic era. Polypharmacy in the elderly is another area where we can have a lot of influence.'