Choosing Wisely hampered by a lack of information

Public Health

By Jennifer Cooke

7 Mar 2019

More than 60 per cent of specialists find that unnecessary tests, treatments or procedures are ordered for patients because of difficulties in accessing information from doctors in other settings.

Specialists, however, were less likely than GPs to be swayed in their practice by patient expectation or worries about medicolegal risk.

These were major findings in the latest NPS MedicineWise Choosing Wisely Australia Report on unnecessary healthcare for 2018 released last month.

In the third survey conducted with GPs and specialists since the inception of Choosing Wisely in 2015, more than half the 234 GPs surveyed also found difficulty getting patient information from other doctors.

Other cited reasons high on the list (more than 40 per cent) for overuse of medical tests and overdiagnosis of health conditions were diagnosis uncertainty and patient expectations.

The potential for medical litigation was a factor in the decisions to order unnecessary healthcare by 37 per cent of the 194 specialists surveyed, while more than half of the GPs surveyed cited the same reason.

Patient expectations was the reason behind unnecessary healthcare for 62 per cent of GPs and 42 per cent of specialists – roughly uniform results over the three annual surveys to date. Conversely, consumers were found to have requested a test in only 14 per cent of cases.

According to the survey results, 23 per cent of specialists found that a patient had been referred specifically for an (unnecessary) test, treatment or procedure.

But only up to 10 per cent of specialists felt that unnecessary healthcare could be attributed to the reasons that it was better to test than not; that the recommended test, treatment or procedure was not available; or for the need to keep patients “engaged”.

The survey of clinicians from the Choosing Wisely Champion Health Services network found that more than 90 per cent believed they had a responsibility to help reduce inappropriate use of unnecessary tests, treatments and procedures.

However significant percentages cited that it was difficult to change existing routines or ways of working. A lack of education or knowledge of Choosing Wisely recommendations to restrict unnecessary healthcare were also factors.

Chair of the Choosing Wisely Australia Advisory Group Dr Matthew Anstey told the limbic that medical tests may still be repeated due to difficulty accessing results from another setting.

“Another challenge is changing the mindset of clinicians around taking the time to explain all the options to patients, which is sometimes harder than just ordering the test.”

An intensivist and co-director of ICU research at Sir Charles Gairdner Hospital and a clinical senior lecturer at the University of Western Australia, Dr Anstey said that increasing the conversations firstly between health professionals, and then between consumers and their doctors about what tests, treatment and procedures are appropriate and necessary is “fundamental” to the success of the Choosing Wisely initiative.

“We’re seeing significant progress from champion hospitals and clinicians undertaking peer review and leading changes to existing practices.”

As well, Dr Anstey said, “growing awareness among consumers that not all healthcare adds value, including time and financial considerations, will help drive change as specialists become more aware these issues are important things to consumers”.

Since 2015, Choosing Wisely Australia has made 189 recommendations about tests, treatments and procedures in lists of five things clinicians and consumers should question, with 26 recommendations made last year.

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