Interventional gastroenterology

Top 5 list of interventions not to do: Choosing Wisely

The  Gastroenterological Society of Australia has published its top 5 list of ‘do-not-do’ interventions and practices.

The list was published as part of the EVOLVE program, a physician-led initiative that encourages each medical specialty to think about the clinical circumstances in which some of their practices – whether medical tests, procedures or interventions – should have their indications or value questioned and discussed by physicians.

Representing the Gastroenterological Society of Australia (GESA), Professor Anne Duggan said the recommendations were not focused on cost savings per se but on achieving “higher value health care”.

“Everybody tries to do the right thing by their patients but healthcare delivery is complex and sometimes there is pressure to do things that are not evidence-based,” she said.

“We’re just reminding people to use tools such as clinical guidelines for the benefit of their patients and to ensure we are using resources wisely.”

She said Choosing Wisely provided a much-needed framework for consumer-focused health care – one that encouraged patients to ask more questions and have fruitful discussions with their doctors.

“Anxiety about symptoms or health conditions can sometimes be better dealt with by conversation and understanding rather than by more tests,” Professor Duggan said.

The recommendations developed by GESA were:

  1. Do not repeat colonoscopies more often than recommended by the National Health and Medical Research Council (NHMRC) endorsed guidelines.
  2. Do not undertake faecal occult blood testing in patients who report rectal bleeding, or require investigation for iron deficiency or gastrointestinal symptoms.
  3. Do not continue prescribing long term proton pump inhibitor (PPI) medications to patients without attempting to reduce the medication down to the lowest effective dose or cease the therapy altogether.
  4. Do not undertake genetic testing for coeliac genes as a screening test for coeliac disease.
  5. Do not perform a follow-up endoscopy less than three years after two consecutive findings of no dysplasia from endoscopies with appropriate four quadrant biopsies for patients diagnosed with Barrett’s Oesophagus.

While independent of the recent MBS Review, the Choosing Wisely initiative also seeks to reduce the use of inappropriate tests, treatments and procedures.

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