In this fourth article in our Choosing Wisely series, Dr Lynn Weekes AM, CEO of NPS MedicineWise looks at how lists of five things can really change the conversation about low value health care and waste when the right people are part of the conversation. Given the organisations involved, this initiative will have much to contribute to the review of the MBS announced by Minister Ley yesterday.
Dr Weekes writes:
This month, Choosing Wisely Australia® launches with lists of low value tests or treatments from five medical bodies. In the vanguard are the Royal Australian College of General Practitioners, the Royal College of Pathologists of Australasia, the Australian College of Emergency Medicine, the Royal Australian and New Zealand College of Radiologists and the Australasian Society of Clinical Immunology & Allergy. Each organisation is developing a list of recommendations: ‘Five things clinicians and consumers should question’. These recommendations and the evidence that supports them will then be shared among the wider health community and more broadly, the general public.
This concept was originally conceived and tested in the United States in 2012 with a small number of initial lists that has today expanded to more than 70 lists created by participating medical colleges and societies to promote the more effective use of health care resources.
The list is the start of a conversation with health consumers about what procedures, tests and treatments may or may not add value to their care. Health consumers also need information about what care they truly need in order to have these conversations with their providers and in the United States, Consumer Reports develops patient-friendly materials and works with consumer groups to disseminate these widely.
Since its inception, Choosing Wisely has gone global and Australia is the latest country to embrace this clinician-led movement to improve health care. Choosing Wisely Australia is setting out to effect a cultural shift by challenging the notion that ‘more is always better’. Australia’s medical colleges and professional societies are leading the way but importantly this is a movement that unites the public and the medical world in rethinking how we should use some tests and treatments.
This initiative will identify and reduce investigations and treatments that are of proven low value. Unnecessary practices are a diversion from high quality care. They can lead to more frequent and invasive investigations that can expose consumers to undue risk of harm, emotional stress and financial cost. It’s about responsible management and fair distribution of finite healthcare resources. For example, we know that imaging is not necessary for most cases of uncomplicated acute back pain and that antibiotics are unnecessary for viral respiratory infections and yet both examples occur commonly.
NPS MedicineWise is taking a facilitation role in the launch of Choosing Wisely Australia by providing criteria to which all colleges and societies have agreed to adhere in developing recommendations. All items on a list should be within that specialty’s purview and control, the items should occur reasonably frequently, there must be good evidence to support the listing and the process for deriving the list must be documented and publicly available. These lists are not complete guidelines but they must be robust.
To be clear, the recommendations are not intended to establish insurance coverage decisions or exclusions. Rather, they are meant to spur conversation about what is appropriate and necessary treatment. As each patient situation is unique, providers and patients should use the recommendations as guidelines to determine an appropriate treatment plan together.
NPS MedicineWise hopes this work will prompt health professionals to start scrutinising the evidence on tests and procedures – and change their practice as a result. Following on from the international experience, the Choosing Wisely campaign will highlight many examples of questionable care for health professionals and patients to reconsider in an Australian context. Choosing Wisely Australia will only be effective if consumers are part of the conversation and are provided with the evidence they need to confidently ask questions about unnecessary and potentially harmful tests, treatments and procedures. It’s also important that Choosing Wisely Australia creates forums for a broader and more public discussion about appropriateness of care.
Choosing Wisely Australia enables the medical community to take a leadership role in the responsible management and fair distribution of finite healthcare resources. The initiative requires a change in practice for both the health professional and the consumer and it will take time and dedicated resourcing to support implementation for the messages of the campaign to take effect. The first five lists will be launched in April 2015 and we anticipate the launch of more lists at a later date in 2015.
Choosing Wisely Australia will start bigger conversations about better healthcare and now is the time for the medical profession to get on board and drive this initiative forward.
Further articles in the choosing wisely series can be found here.
Dr Lynn Weekes: As inaugural chief executive officer of NPS MedicineWise, Lynn has contributed significantly to the development of quality use of medicines (QUM) resources and services for health professionals and consumers in Australia since 1998.
In the 2013 Queen’s Birthday honours Lynn was appointed as a Member of the Order of Australia for her significant service to Australian community health through the promotion of quality use of medicines.
With her expertise in the QUM area Lynn sits, by invitation, on various national boards and committees from government, pharmacy and academic sectors.
As part of her PhD thesis, Organisational Structures to Promote Quality Use of Medicines, Lynn developed indicators for QUM for drug and therapeutics committees and for hospitals more generally. She has a strong professional interest in quality assurance, behaviour change and pharmacoepidemiology.
Prior to Lynn’s appointment to NPS MedicineWise, she was executive officer of NSW Therapeutic Assessment Group where she was involved in drug use practice, evaluation and policy. She originally trained as a pharmacist and practised in hospital and research settings.
Choosing Wisely Australia is facilitated by NPS MedicineWise, an independent, not-for-profit, evidence-based organisation that promotes quality use of medicines and medical tests. The Choosing Wisely Australia initiatives is health profession led.