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Dr. Joshua Tepper

Choosing Wisely: Wise Choices for Quality Care

As one of the largest quality improvement initiatives in Canada, Choosing Wisely Canada has made impressive progress over the 3.5 years of its existence.

Physicians and patients working together to avoid treatments, procedures or tests that may not be necessary, or may even be harmful to patients is an important part of a quality health care system. It is also the driving force behind Choosing Wisely Canada, with whom Health Quality Ontario has partnered in this province.

Started in the U.S. in 2012 and quickly adopted in Canada with involvement from more than 70 medical associations, Choosing Wisely Canada encourages clinicians and patients to engage in conversations about unnecessary tests and treatments, and make informed choices to improve care. While Choosing Wisely is an international movement, the work that has been done in Canada is often leading the way globally.

Why is an initiative such as Choosing Wisely Canada necessary? The Canadian Institute of Health Information (CIHI) issued a report last year showing up to 30% of selected tests, procedures and treatments in Canada are potentially unnecessary. This translates to Canadians being potentially subjected to more than one million unnecessary tests and procedures yearly.

Recently, 300 delegates gathered in Toronto to hear about progress made with Choosing Wisely campaigns across Canada. Attendance reflected the unprecedented degree to which Choosing Wisely Canada has broken down silos between patients and providers, learners and practitioners, generalists and specialists, and governments and medical associations. Other health-care providers such as nurses, pharmacists and dentists are also involved because – as Choosing Wisely Canada leader Dr. Wendy Levinson says, “(reducing) overuse is a team sport”.

A year ago, Health Quality Ontario released a report documenting the steps clinical leaders and teams in Ontario have taken to support implementation efforts to reduce unnecessary care in Ontario. It showed how clinicians on the ground in many sectors are embedding Choosing Wisely Canada-related projects in organization-led quality projects and/or how larger efforts align with Health Quality Ontario’s broader work on quality.

At this year’s Choosing Wisely meeting, several presentations featured Ontario’s ARTIC Choosing Wisely project involving four hospitals and six family health teams in the Greater Toronto area. ARTIC (Adopting Research to Improve Care) is a joint program of Health Quality Ontario and the Council of Academic Hospitals of Ontario dedicated to accelerating the spread of evidence-based advances in health care throughout the province. The project is reducing medications such as proton pump inhibitors, glyburide and sedative hypnotics which are often overprescribed in primary care, and reducing pre-operative and emergency department laboratory testing in hospitals.

The unity, speed of delivery and innovation displayed by the Choosing Wisely Canada initiative is a shining example of what can be done in quality improvement - locally, regionally and nationally.

But while the successes are impressive, work now must focus on building a sustained and coordinated presence, and normalizing the practises and beliefs of the converted with all providers. “Are we ‘choosing wisely’ has become part of our lingo,” said Dr. Kimberly Wintemute, medical director of the North York Family Health team which was part of the ARTIC initiative at the Toronto conference.

In a system often plagued by negativity, Choosing Wisely Canada is a reason for optimism.


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