VIDEO: #ChoosingWisely in Cypress Health Region

Since 2015, The Saskatchewan Health Quality Council has been moving forward the very important agenda of Appropriateness of Care.

 

In partnership with the Saskatchewan Medical Association, they have now launched Choosing Wisely Saskatchewan and are working engaging patients, clinicians, and learners to implement a province-wide strategy to tackle overuse. To start, they are focussing on pre-operative testing and imaging of lower back pain, and some of the health regions are taking on their own projects.

The Cypress Health Region has demonstrated their commitment to Choose Wisely:

Here's hoping many people will see their example and make the same pledge to choose wisely - because more is not always better in healthcare.

Source: https://www.youtube.com/watch?v=gkqKRYpKbQ...

Taking Action on Overuse: A Framework for Change (for Health Orgs & Institutes)

It has been a while since I discovered any new organizations doing work on the topic of overdiagnosis and the related issues of overtesting and overtreating. Many different projects and initiatives explore the subject; some, like Choosing Wisely, make lists of 'do not do' recommendations. Others, like Minimally Disruptive Medicine provide thoughtful reflection and model practices to show us how to burden our patients less and engage them more. The Lown Institute and their Right Care Alliance work at many levels, be it in political advocacy, cultural change, or clinical education. 

The Right Care Alliance is sponsored by the Robert Wood Johnson Foundation, something it has in common with Taking Action on Overuse.  While the former is more directed at patients, clinicians, and policy-makers, Taking Action on Overuse is a group that seems devoted to supporting health organizations and institutions. Organizations interested in creating changes to provide fewer unnecessary or harmful tests, treatments, and procedures, can employ the tools Taking Action has created. 

In their words, "Taking Action on Overuse is an evolving framework for health care organizations to engage their care teams in reducing low-value, unnecessary care and make those efforts last. It identifies evidence-based strategies for obtaining buy-in, motivating behavior changes, and providing the necessary support and infrastructure for health care providers to engage and lead their peers in making the changes that improve the value of health care."

Their Assessment can help you figure out whether your institution is ready with best practices, and gently guide you there. Likewise, their Framework can help you create the right conditions for change in a climate where many still believe "more is always better."

Check out their website here to learn more.

Source: https://takingactiononoveruse.org/

VIDEO: What causes antibiotic resistance? Kevin Wu | TED-Ed

It is goofy (there are butt-faces, silly monsters, Salmonella shooting lasers, and even a fart scene at 2:22) and informative. It is bound to be a classic!!!

Watch this fun video explaining What Causes Antibiotic Resistance thanks the Kevin Wu and Ted Ed.

View full lesson: http://ed.ted.com/lessons/how-antibiotics-become-resistant-over-time-kevin-wu Right now, you are inhabited by trillions of microorganisms. Many of these bacteria are harmless (or even helpful!), but there are a few strains of 'super bacteria' that are pretty nasty -- and they're growing resistant to our antibiotics. Why is this happening?

Source: http://ed.ted.com/lessons/how-antibiotics-...

A summary: How to prevent #overdiagnosis @SwissMedWkly

For anyone who is even remotely interested in the movement to prevent overdiagnosis, I suggest you check out this article, How to Prevent Overdiagnosis, in its entirety.

Dr Arnaud Chiolero et al. have provided a thorough overview of the causes of overdiagnosis, methods to estimate the frequency of overdiagnosis, and interventions to prevent overdiagnosis.

As a teaser, I present to you the summary tables from the article:

We all might argue about the exact contributors to overdiagnosis, but this list (based on a review of the literature) is pretty thorough. Fortunately there is hope to combat the problem, and some specific examples are given:

See the article or follow Dr Chiolero (@swissepi) on Twitter for more.

Source: http://www.smw.ch/content/smw-2015-14060/

7 Themes from Preventing Overdiagnosis #PODC2014

In September I was lucky enough to attend the Preventing Overdiagnosis conference in Oxford, UK. I learned about new resources and people that I could connect with, changed some of my beliefs, and generated even more questions for myself/the health care system.

In my reflection, 7 major themes emerged:

  1. Nomenclature

    • under-use is as much an issue as over-use
      • like food, we want our medicine neither over- nor under-cooked [David Haslam]
    • how do we define the problem? what terms are being used to describe this/similar issues? [see glossary for some] can we create a common term?
    • causes of overdiagnosis are on a spectrum
      • good intentions -- wishful thinking -- vested interests [Stacy Carter]
         
  2. Cognitive/Labeling Biases = Problematic

    • flawed thinking: doing something better than nothing, "more is better"
      • the more resources exist, the more they are used
    • actions motivated by fear (of death, illness, uncertainty)
    • labeling bias
      • is there any other way we can see patients besides by labeling them with diagnoses? [William House, Andrew Morrice]
      • creating a "WAR ON CANCER" galvanizes people, breeds an ideology and creates fundamentalists
         
  3. It Is about conversations, not certainties

    • mostly grey areas, no blanket rule for everyone; evidence, guidelines, recommendations must be interpreted for each patient
    • pathology is a continuum, never/rarely yes or no
    • "correct" is not always effective

    • use existing skepticism/understanding to inform others

      • eg. people have begun to understand the harms of the overuse of antibiotics; parlay that into other areas
         

  4. Individuals vs. populations

    • for Patient X to not have a stroke, 76 other people have to be on statins
    • it is not possible to know at an individual level if something is overdiagnosis
    • evidence often does not apply to the person sitting in front of you
       
  5. Health Care delivery is flawed

    • changing the way we delivery primary care might be the heart of the solution
    • "consumer"-driven Predictive, Preventive, Personalized, Participatory (P4) medicine is scary & narcissistic [Henrik Vogt]
    • neo-paternalism may have a role
    • industry is scary
      • for-profit medicine is the biggest enemy of "Less is More Medicine"
      • this drives the medicalization of normal life, which makes us sicker!
    • the technology for genetic-based medicine is a long way off from being helpful
       
  6. Screening fails in ways we never imagined

    • patients equate screening with access to care [Laura Batstra]
    • "why is screening exempt from the ethical responsibilities to do no harm?" [Alexander Barratt]
    • preventative medicine has disappointing outcomes [Linn Getz]
       
  7. Evidence is lacking

    • it's not just a lack of quantity or quality
    • do we really need clinical trials to prove the obvious? can't we just do the right, ethical thing? [Dan Mayer]

Did you take away the same points as I did? Something completely different?

I'm already looking forward to the conference next year, in Bethesda, USA.