Yesterday I interviewed Karen Born, Knowledge Translation Lead, Choosing Wisely Canada. I wanted to talk to Karen about the success of the initiative in Canada as it is too soon to know if the initiative will be successful in the UK. Some providers simply do not know about it yet and others haven’t had the chance to implement it yet. The initiative was launched on the 24th of October 2016.
When was Choosing Wisely implemented in Canada?
Dr Wendy Levinson who was the chair of the Choosing Wisely campaign sat on the board of the ABIM foundation at the time when the initiative was launched in the USA and she wanted to bring it to Canada, so choosing wisely Canada was launched in spring of 2014, over two years ago.
Is the initiative working in Canada?
I would say there’s different ways we are measuring the impact of Choosing Wisely campaign so in quality improvement and in health care measurement we talk about measuring structure, process and outcome. So these campaign are very early stage and a really key goal of the campaign is to engage physicians and patients in conversation so can we measure or not if these conversations are happening? That’s really difficult because we can’t get into the exam rooms but we can measure patient attitude and providers attitude. So we do see a high level of physician awareness in Canada, over 80% of physicians were aware of choosing wisely Canada.
What could be improved about the initiative?
Choosing Wisely Canada I think there’s a few pieces we are trying to grow and strengthen so we do have a publicly facing campaign. To date most of our outreach efforts have been to physicians but we have had a lot of penetration among physicians, a lot of interest and now we need to do the tough work of reaching to the general public.
Do you think the initiative will work in the UK?
I hope so, in the UK I think the NHS is a very important part of the culture and identity of people in England and I think people have a high expectation of it but also understand that it is a publicly funded health care service so there needs to be trade off. I think the patient culture and physician culture in the UK will be open to Choosing Wisely. Choosing Wisely doesn’t just resonate in Canada or the USA, there’s choosing wisely campaigns everywhere.
Do the 5 questions patients have been told to ask their providers, do it make a difference?
The questions have been a really effective tool, one thing we did for our public and patient engagement is that we created posters, our more isn’t always better posters and we sent that out with the family medicine journal which goes to family physicians and asked them to put that up in offices and they included the questions. Our hope is that when people are in their doctor’s office and see that poster, it would encourage them to think about over use and over treatment. But people are bombarded with so much information these days so we ask people to take a picture of it as they leave. But they may not work with all patients, not everyone is comfortable asking questions.
Are there any obstacle you’ve had to overcome with Choosing Wisely?
Yes I think change can be difficult but I think overall most physicians and patients have been receptive to this message. One of the obstacles is really about framing what this campaign really is about and what it is not about. People are always fearful about of rationing and having healthcare taken away from them. This is not about that, it’s about doing less of what we know do not need. Always going back to the evidence and staying on the message and being clear about what the campaign is.
Do you think doctors will implement Choosing Wisely?
Yes, we have seen a lot of implementation already around choosing wisely, doctors using Choosing Wisely recommendations to drive their next quality improvement practice projects. People are saying this just makes sense to me, this makes sense for my practice and I want to do it. People are being given certain tools and training and different approaches to implementation but there is a huge range of doctors out there, those who will change their practice because of choosing wisely and those who will not.
*Sadly I did not use this interview for my MMP Project, nevertheless, it did give me an insight into the possible future of Choosing Wisely UK