61 tests, treatments that could cause harm

The Choosing Wisely Australia campaign has today released 61 recommendations of tests, treatments and procedures that may not be necessary and could cause harm to Australian patients.

The 61 recommendations are being released today by the next wave of 14 Australian colleges, societies and associations who have united to join the initiative.

They represent a broad spectrum of health care providers, including hospital pharmacists, surgeons, nurses, dermatologists, ophthalmologists, infectious disease specialists, haematologists, endocrinologists, physiotherapists, palliative care specialists, intensivists and general practitioners. The initiative is health profession-led and facilitated by NPS MedicineWise.

Sending a strong message on providing the best quality care for Australian patients, several unifying themes have emerged across the lists of “Five things clinicians and consumers should question”, including appropriate use of imaging and screening, use of antibiotics and improving end of life and palliative care.

Urgent need for action—choosing antibiotics wisely

15% of the wide-ranging Choosing Wisely recommendations focus on the urgent need for appropriate and responsible use of antibiotics by all, to reduce further development of antibiotic resistance.

Recommendations include ensuring appropriate antibiotic use for urinary tract infection, upper respiratory infection, leg ulcers, epidermal cysts, acne, and daily consideration of antibiotic de-escalation for intensive care patients.

Dr Frank R Jones from The Royal Australian College of General Practitioners says, “Middle ear infection is a common reason for children aged 2 to 12 years to present to their GP, and we recommend against routine use of antibiotics for this age group.

“Regardless of whether one or both eardrums are red or bulging, antibiotics do not reduce pain at 24 hours. The small benefits of antibiotic use must be weighed up against the risk and potential side-effects such as rash, diarrhoea, or vomiting.

“Furthermore, antibiotic use promotes bacterial resistance, both in the individual and community. Although we do not suggest antibiotics should never be used for ear infections in children (the guidelines differ for Aboriginal and Torres Strait Islander children and for infants under six months), we are reminding doctors and parents that it is also safe to not use antibiotics in routine situations where the evidence suggests it won’t help the child.”


End of life and palliative care

The Choosing Wisely Australia recommendations on end of life focus on optimising care for patients in various settings (such as ICU, the emergency department and palliative care) and the decisions that should be considered by clinicians, families and patients.

The list items include recommendations on early discussion on advance care planning, early palliative care referral, use of oxygen for non-hypoxic patients, percutaneous feeding in advance dementia and medication reviews to avoid drug interactions.

Dr Simon Allan from The Australian and New Zealand Society of Palliative Medicine says, “It’s important not to delay conversations around end of life and palliative care.

“One of our recommendations is to not delay discussion of and referral to palliative care for a patient with serious illness.

“Early access to palliative care has been shown to reduce aggressive therapies at the end of life, prolong life in certain patient populations, and significantly reduce hospital costs.”

Professor Michael Dooley from The Society of Hospital Pharmacists of Australia says, “One of our ‘top five’ recommendations is to not initiate or continue medicines to prevent disease in patients who have a limited life expectancy.

“Medications should only be used when there is a clear benefit to the patient and when this benefit outweighs the potential for adverse effects.

“Regular review of the ongoing need for each medicine and stopping medications that no longer provide a benefit is an integral component of care and can reduce adverse effect, costs and burden on patients.”


Unnecessary imaging and screening

Routine imaging can cause adverse events, lead to further unnecessary investigations and may cause unnecessary exposure to radiation.

To reduce unnecessary care, new Choosing Wisely recommendations include questioning chest x-ray for uncomplicated acute bronchitis, thyroid ultrasound, ultrasound for groin hernias, endoscopy for gastric band patients, imaging for non-specific low back pain and x-ray for foot and ankle trauma.

Michael Donovan, Royal Australasian College of Surgeons/President, General Surgeons Australia says, “As an example of identifying tests, treatments and procedures that carry unnecessary risk for patients, one of our recommendations centers on reducing radiation exposure. That is, to not use CT scan for the evaluation of appendicitis in children and young adults.

“Ultrasound is the preferred first approach, as it is cost-effective, reduces potential radiation risks for children and has excellent accuracy”.


Sparking conversations about what care is truly necessary

The goal of the Choosing Wisely Australia initiative is to spark conversations between patients and clinicians about what care is truly necessary for specific conditions. Each of the lists is developed by the individual college, society or association using the most current evidence about management and treatment options.

Dr Lynn Weekes, CEO of NPS MedicineWise says, “With two thirds of Australia’s medical colleges now committed to Choosing Wisely Australia, the initiative has grown to be an important force and voice in healthcare. 86 recommendations have now been released since the initiative launched less than 12 months ago.

“The new wave launch sees a diversification of healthcare providers and I congratulate everyone on the release of their lists today, all which will improve patient care. Choosing Wisely sparks important conversations in Australia on unnecessary care to ensure that healthcare resources are being used most effectively.”

Four in 10 recently surveyed Australians said they did not ask questions during their last health care appointment.

One in five replied that they did not know what to ask. Today, consumer resources are also being launched on the Choosing Wisely Australia website, that list the questions Australians should be asking their health providers about tests, treatments and procedures.

These questions are available in 10 community languages.


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