COURSE: Practising Wisely - Reducing Unnecessary Testing and Treatment

When I speak to peers and clinicians, one of the most frequent bits of feedback I receive is "Great! I'm on board with delivering more appropriate care, Choosing Wisely, making sure my patients make shared decisions and avoid unnecessary tests and treatments. But... I don't really know how to 'do' it. Where do I start? How to I talk to patients? Where do I go to practice?"

So, it is with extreme pleasure that I announce the expansion of the Practicing Wisely: Reducing Unnecessary Testing and Treatment Course. Originally "Don't just do something, Stand there!," this highly-regarded hands-on learning experience was started by the Ontario College of Family Physicians and is spearheaded by Dr Jennifer Young.

It is now a suite of continuing professional development opportunities for primary care providers, available in a modular format across the country. In the course: 

Participants will identify opportunities to "practise wisely", with a focus on reducing over-prescribing, over-imaging, over-screening and over-monitoring using the latest evidence and tools from diverse sources. This workshop aligns closely with the Choosing Wisely Canada (CWC) campaign to implement good healthcare stewardship and avoid over-medicalization.

The program centres on case studies and incorporates individual reflection and group work. It helps participants to build communication skills to guide their patients through the shift from seeking sickness to enhancing health.


After active engagement in this program, participants will be better able to:

  • Identify opportunities to reduce “too much medicine”
  • Access and assess reliable, renewing online resources
  • Integrate relevant evidence into individual patient care
  • Communicate and build consensus with patients to reduce over-medicalization

    Upcoming Workshops are taking place as follows:

    May 24/17 - Montreal
    May 29/17 - Ottawa
    June 3/17 - Newfoundland
    Nov 22/17 - Toronto

    Find out more about the Practising Wisely program by viewing the main website or reading through this Q&A with Course Director, Dr. Jennifer Young.

    Source: http://ocfp.on.ca/cpd/practising-wisely

    Toolkits from Choosing Wisely Canada

    At the Choosing Wisely national meeting March 30th, Choosing Wisely Canada (CWC) announced a new direction.

    In lieu of the 10 million challenge, they are instead putting significant effort into empowering CWC enthusiasts by way of facilitating "DIY Toolkits."

    These tool-kits are PDF documents, starting with a catchy title and cover art (provided by CWC), and filled with user-generated content, meant to enable you to apply some of the Choosing Wisely recommendations to your institution or practice. So far, the topics include reducing unnecessary indwelling (Foley) catheter use, proton-pump inhibitor prescriptions, 2nd units of red blood cell transfusions, pre-operative investigation, and sedative/hypnotic use in the elderly.

    Click on the image below to check out the first 5 or go to the page to learn how to submit your own:

    Source: http://www.choosingwiselycanada.org/in-act...

    Quality Forum: A New Kind of Rounds (Teaching patient-centred care that avoids unnecessary and harmful interventions)

    I have followed the Do No Harm project and their articles in JAMA's Teachable Moments section (under the Less is More theme). Then, at the Lown Institute's Road to Right Care conference, I learned more about "Right Care Rounds," and in Nanaimo we developed our own version.

    More background information and the talk from our first session, on the subject of treatment of Type 2 Diabetes in the elderly, can be found here.

    Following the success of this event, we decided to do more of them. Our next one is tentatively in April and will be on the subject of overtreatment of hypertension. Thinking, "why not spread the message of what we are trying?," we've created a poster that I will present at the BC Quality Forum.

    You can view the full poster 'storyboard' by clicking the image below.
     

    A New Kind of Rounds: Type 2 Diabetes in the Elderly CME

    Thanks to my local Division of Family Practice and the Practice Support Program (PSP), we were able to put together "A New Kind of Rounds" event all about helping patients find the right amount of medicine. 

    Our first event, focussed on Type 2 Diabetes in the Elderly, and specifically the harms of treating this too aggressively. Inspired by the Lown Institute's RightCare Rounds and the DoNoHarm Project, we started with patient cases in which the patient's perspective highlighted the burden of treatment and the potential harms of too much medicine.

    After small-group case learning, I presented a didactic session reviewing the unique factors that change our approach to management in the elderly, the best available evidence on diagnosis and treatment targets, the current guidelines, and some resources that clinicians and patients can refer to in order to make shared decisions about the "right amount" of care.

    The event was well-attended and it was heartwarming to see the level of engagement on this topic from clinicians in our community; we are reviewing the evaluations to consider some changes to the format. Participants also generated an amazing of possible topics for future events, from hypertension to cancer-screening, and anti-psychotic use in the elderly to the annual physical. 

    The slides are available here.

    Your feedback is most welcome. You can comment below or e-mail. 

    My other lectures can be viewed here.

    Source: http://prezi.com/ln78vzbqpu4-/?utm_campaig...

    The Most Important #ChoosingWisely List: Med Students & Trainees

    Please join me in enthusiastically applying the latest Choosing Wisely Canada recommendations, as developed by the Canadian Federation of Medical Students (CFMS) and the Fédération médicale étudiante du Québec (FMEQ).

    This amazing list of 6 items for Medical Students and Trainees to question is extremely important. It does a few things above and beyond what the other Choosing Wisely Canada lists could. Namely, the list:

    • Creates and promotes a culture of appropriateness in care early on in the careers of physicians, ensuring this way of thinking is embedded in their style of practice
    • Recognizes the professionalism, critical-thinking ability, and ethical intelligence of young clinicians
    • Engages medical educators and recognizes the mutual influence that learners and instructors can have on each other's practice
    • Is directed squarely at providers; while discussion between patient and provider may seem notably absent, each of the items is patient centred at a high-level; the list ensures that the goals of the patient – not the learner – are paramount, and that the learner will advocate in this regard

    Hopefully the Students and Trainees Advocating for Resource Stewardship (STARS), students selected to champion the Choosing Wisely campaign, will be able to integrate these Top 6 into their medical schools' curricula.

    Congratulations to the members of CFMS, FMEQ, and STARS on this fantastic work.

    Review the 'Six Things Medical Students and Trainees Should Question' list.

    Source: http://www.choosingwiselycanada.org/recomm...

    Transfusion Medicine for Physicians

    Did you know that there is an online, CME-Accredited course regarding the use of blood products?

    In the area of transfusions, Less is often more!

    Emergency and Family physicians, hospitalists, internists, residents and surgeons could all benefit from learning the when, why, and hows of transfusion.

     

    See the PDF Flyer or go to the website to learn more and register!

     

    Overall Learning Objectives:
    After participation in this course, the learner will:

    1. Appropriately interpret clinical signs and symptoms of reduced oxygen carrying capacity and utilize hemoglobin concentration to determine need for RBC transfusion.
    2. Be confident their RBC transfusion ordering practice is up to date and reflects current literature.
    3. Apply the appropriate elements of informed consent for transfusion.
    4. Appreciate the indirect relationship of common coagulation tests to bleeding risk and the role of frozen plasma transfusion.
    5. Recognize and respond appropriately to adverse transfusion events or reactions.
    6. Know where to seek further advice on transfusion management.

     

    Source: http://www.pbco.ca/index.php/education/phy...