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Choosing Wisely update: keep questioning the need for tests and treatments

Australia’s Choosing Wisely initiative recently added more items to the list of tests, treatments and procedures that have little or no clinical benefit, and might cause harm.

This comes as the global pushback against  overdiagnosis and overtreatment gathers momentum: a hot topic at this week’s Cochrane Collaboration Colloquium in Seoul is the need to anticipate and include include these considerations in systematic reviews (more on this at Croakey, later this week).

Below, Dr Robyn Lindner, Client Relationships Manager for NPS MedicineWise, highlights some of the recent additions to the list, as well as five simple questions that will empower consumers to have conversations with their healthcare providers, and give both parties the freedom to make better choices.


 Dr Robyn Lindner writes:

We are fortunate as Australians to have access to one of the best healthcare systems in the world, but the clinical environment has become increasingly complex.

As technology keeps changing and treatments keep evolving, we need better ways to assist consumers to make the right healthcare decisions.

Head of the Sydney University Medical School and chair of the Government’s MBS Review Taskforce, Professor Bruce Robinson, said at the launch of the MBS Review in 2015 that an estimated 30% or more of health expenditure is wasted on services, tests and procedures that provide no or negligible clinical benefit and, in some cases, might be unsafe and could actually cause harm.

Choosing Wisely in Australia: the list grows

The Choosing Wisely Australia® initiative is raising awareness of these issues. We work closely with the medical profession and consumers about the need to question the necessity of particular healthcare approaches, with the ultimate aim of improving the quality of health outcomes for Australians.

For instance, men with prostate cancer can opt for radiation therapy and surgery, but those managing low-risk prostate cancer are being asked not to accept radiation oncology as their only option. The Royal Australian and New Zealand College of Radiologists Faculty of Radiation Oncology is now advising men to consider active surveillance or close monitoring first.

Also recently called into question are direct-to-consumer genetic tests for conditions such as coeliac disease. These tests are relatively affordable, but are they beneficial?

A high proportion of Australians (around one third) carry coeliac genes. However, according to Professor Anne Duggan from the Gastroenterological Society of Australia, genetic testing for coeliac disease is not recommended, because a positive test will not predict with any certainty that you will develop the disease.

Instead, serological testing is recommended as the appropriate first line screening test for coeliac disease (with the patient consuming the appropriate amount of gluten).

Similarly, testing for the APOE gene – considered a risk or susceptibility factor for Alzheimer’s disease – has been reviewed by the Human Genetics Society of Australasia.

Its latest recommendation is people do not undertake genetic tests for APOE, as a test only shows a probability of getting the disease and can also give false reassurance to people who return a negative result.

These are just three of 25 new recommendations released by Choosing Wisely Australia earlier this month, on behalf of Australia’s specialist medical colleges and societies.

Facilitated by NPS MedicineWise, Choosing Wisely launched in April 2015 on the back of the initiative’s success in the United States in improving the quality of healthcare for Americans. The end goal is helping reduce the number of unnecessary tests, treatments and procedures being undertaken.

In Australia, more than 70% of medical colleges, societies and associations have committed to the Choosing Wisely initiative.

To date the initiative has released 123 recommendations on tests, treatments and procedures that may not be necessary, or could cause harm. This is a great start, but just the beginning of an important national dialogue about how we can improve the healthcare sector.

Empowered conversations

A key step is actively encouraging consumers and doctors to have better conversations around care approaches, to fully explore all options and risks based on the latest expert advice from the medical profession. With this in mind, Choosing Wisely has developed five questions consumers can ask their healthcare providers before agreeing to any test, treatment or procedure.

In brief, they are,

Do I really need this test or procedure?

What are the risks?

Are there simpler, safer options?

What happens if I don’t do anything?

What are the costs?

We are also working with general practitioners and establishing pilot sites in a number of hospitals to foster greater engagement with the initiative right at the coalface.

No doubt there is, and will continue to be, a myriad of challenges facing healthcare professionals about the tests and treatments to offer, and for consumers to make those final decisions on their own healthcare plans. What is the most appropriate course of action? What will provide the best outcome?

As can be seen in many of the Choosing Wisely recommendations, sometimes it could be the case that doing nothing is doing something. This is why we all need to keep asking questions and having these important conversations.

Dr Robyn Lindner is the Client Relationships Manager, NPS MedicineWise. On twitter @NPSMedicineWise

 

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