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Choosing Wisely Canada: the national voice for reducing unnecessary tests and treatments

June 5, 2024
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Dr. Kelly Burak discusses the organization’s work and how pharmacy teams can help.
Portrait of Dr. Kelly Burak, Assistant Dean of the Continuing Medical Education and Professional Development and Physician Learning Program at the University of Calgary
Dr. Kelly Burak, Assistant Dean of the Continuing Medical Education and Professional Development and Physician Learning Program at the University of Calgary

According to Dr. Kelly Burak, Assistant Dean of the Continuing Medical Education and Professional Development and Physician Learning Program at the University of Calgary, the benefits of reducing unnecessary tests and treatments across healthcare settings are significant.

“We can expect healthier, happier patients; lower costs and improved sustainability; improved work satisfaction for healthcare providers; and increased equity,” said Kelly.

What are unnecessary tests and treatments? Choosing Wisely Canada is a national organization that has been working to spread awareness about this issue since 2014. They have identified a number of tests and treatments where strong scientific evidence demonstrates a lack of helpfulness to patients in particular circumstances or the possibility of exposing patients to unnecessary harm.

Kelly has been involved with Choosing Wisely Canada since 2017. Over those seven years, Kelly said the work of the organization has expanded significantly.

“It started as a public awareness campaign about unnecessary, low-value care in Canada,” said Kelly. “It’s really grown from there into implementation science, knowledge translation, and how we can actually change prescribing behaviours.”

Central to the work of Choosing Wisely Canada are recommendations regarding tests and treatments to question, organized by clinical specialties. These recommendations, each developed by professional societies representing different clinical specialties in Canada, identify frequently overused tests and treatments that are not supported by scientific evidence and may unnecessarily expose patients to harm. Choosing Wisely Canada encourages healthcare providers and their organizations to adopt these recommendations and make them part of routine practice.

The organization lists six recommendations for hospital pharmacy and another six for pharmacists. These lists were developed by pharmacists and experts through working with the Canadian Society of Hospital Pharmacists and the Canadian Pharmacists Association. Kelly explained that pharmacy teams play a critical role in reducing unnecessary treatments and deprescribing.

“A pharmacist can play an important role in the medication review and can coordinate that deeper dive into why medications are really necessary,” said Kelly. “Deprescribing is a complex process that takes a lot of time to do well. It’s not a matter of saying ‘this drug has side effects, you shouldn’t take it.’ We need to sit down and have conversations with patients and engage in shared decision making.”

Kelly described pharmacy teams as the quarterback, critical to the patient’s healthcare team and well-equipped to champion the patient’s needs and interests.

“We’re always reluctant to stop a medication that someone else has started, but pharmacy professionals are well positioned to start conversations with the other healthcare providers involved in the patient’s circle of care.”

Kelly said, as a practising liver specialist, he appreciates when pharmacy teams reach out to him to learn more about why a patient needs a certain medication and to bring up the possibility of deprescribing.

“It’s about reaching out and making sure everyone is on board with the same plan,” he added.

Kelly recognized that this work can be time consuming and challenging, but he encourages pharmacy teams to explore Choosing Wisely Canada’s resources and consider implementing the organization’s recommendations into their practices. He breaks down the impacts of reducing unnecessary tests and treatments into four main benefits.

1. Healthier, happier patients

First and foremost, Kelly explained, low-value care can lead to patient harm.

“It is really about person-centred care and what’s best for patients,” he said. “Unnecessary medications can lead to side effects which leads to further prescribing or treatments, some of which ultimately have bad outcomes for the patient.”

When patients can avoid side effects, save money on prescriptions, and save time by avoiding unnecessary testing, their quality of life can be impacted.

2. Lower costs and improved sustainability

Kelly added that unnecessary tests and treatments also contribute to unnecessary spending in our healthcare system.

“We have a finite amount of money to spend on health care in Canada,” said Kelly. “As our population ages, it becomes that much more important to use our resources wisely—it’s good for patients, and it’s good for the sustainability of the healthcare system.”

Also, fewer prescriptions being dispensed could lead to less waste of unused medications, which may have a positive impact on the environment.

3. Improved work satisfaction for healthcare providers

As a healthcare provider himself, Kelly hopes that reducing unnecessary tests and treatments will lead to improved and more efficient care, and a more satisfied workforce.

“Ultimately, I don’t think anybody wants to do work that is unnecessary—hopefully these efforts will contribute to joy of work for healthcare providers knowing that we’re doing something that’s good for the system and good for our patients.”

4. Increased equity

Kelly said that Choosing Wisely Canada is focused on improving equity in access to and quality of care.

“Our group is working hard to build an equity lens into our projects because we’ve recognized that overprescribing is not always done the same.”

Kelly explained that women are more likely to get sedative medications; patients who are treated virtually may receive different treatment compared to patients who are seen in person; those for whom English is not their first language may be treated differently; and seniors are more likely to experience overprescribing.

“We’ve been working to address these inequities and improve access to care,” said Kelly.

Kelly reflected on his personal experience of examining low-value care in his own practice.

“One of the first projects I took on was exploring low-value care in my own department. Despite guidelines saying you don’t need to do particular tests for certain indications, there were still a lot of these tests being ordered and performed,” he said. “When we actually showed that data to our colleagues and we had conversations about how we can change and why we’re doing this, it led to quite a significant reduction.”

Kelly appreciates that efforts to reduce unnecessary tests and treatments are increasing. From individual practices to provincial work to national advocacy, there are more questions being asked and more conversations occurring.

“There are multiple efforts in Alberta to decrease low-value care and Choosing Wisely Canada is one important part of that,” he said.

Pharmacy teams are encouraged to explore Choosing Wisely Canada’s resources and recommendations and consider how reducing unnecessary tests and treatments could benefit the health and well-being of your patients.