Time to question unnecessary testing: Choosing Wisely

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Last night’s ABC Four Corners program investigating unnecessary testing and treatments was a timely reminder of the need for both clinicians and consumers to question low-value care in the Australian health system.

While the recently announced MBS Review will undertake an important and comprehensive examination of the alignment of publicly-funded services with contemporary and evidence-based clinical practice, the recent establishment of the health profession-led initiative, Choosing Wisely Australia, says it provides a forum for clinicians and consumers to improve conversations and decision making about unnecessary and potentially harmful healthcare.

Since launching in April 2015, 13 professional medical colleges and societies have joined the Choosing Wisely Australia movement and have released or are developing lists of five tests, treatments and procedures to question based on evidence of low or no value for consumers. A consumer resource—‘Five questions to ask your doctor’—is designed to support more informed conversations and decision making.

Modeled on international approaches, Choosing Wisely Australia is guided by an advisory group comprising health professionals and consumers and including Associate Professor Adam Elshaug who featured on the Four Corners program.

The Four Corners investigation covered the rapidly rising costs to the health system of imaging for low back pain. Concerned about the impact on the health system of unnecessary testing for low back pain, the Royal Australian and New Zealand College of Radiologists highlighted this test as one that clinicians and consumers should question.

“Low back pain is the third most common health complaint seen by Australian general practitioners. Imaging for acute low back pain is one of the tests to feature on our list—it is not recommended for patients with non-specific low back pain, which are the majority of these patients,” says Professor John Slavotenik from RANZCR.

“Imaging is only indicated initially if the patient has indicators of a serious spinal condition, spinal canal stenosis or sciatica.

“Adopting this recommendation on lower back pain, as well as our other Choosing Wisely Australia recommendations on imaging will result in improved imaging access to appropriate and quality tests and better patient care.”

Another recommendation already listed by Choosing Wisely Australia and examined in detail by Four Corners is PSA testing.

The Royal College of Pathologists of Australasia recommends not performing PSA testing for prostate cancer screening in men with no symptoms and whose life expectancy is less than seven years.

“Choosing Wisely Australia is stimulating informed conversations about the right care, with the ultimate goal to ensure delivery of high-quality healthcare for Australians by reducing inappropriate care,” says Dr Robyn Lindner, NPS MedicineWise spokesperson.

“The investigation by Four Corners highlighted the high costs of low value care. Choosing Wisely Australia will continue to proudly lead the conversation on appropriate care, with the initiative gaining momentum and further lists of tests, treatments and procedures to question due for release in 2016,.”

Twenty five recommendations from colleges and societies along with the five questions that consumers should ask their health professional are located on the Choosing Wisely Australia website. More recommendations will be available in early 2016.

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