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Prescribing and testing by primary care providers to assess adherence to the Choosing Wisely Canada recommendations:
Alexander Singer1, Leanne Kosowan2, Alan Katz1
1Departments of Family Medicine (Singer, Kosowan, Katz, Jolin-Dahel, Appel) and Community Health Sciences (Katz, Lix), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba; Manitoba Primary Care Research Network (Singer); Manitoba Centre for Health Policy (Katz), Winnipeg, Man.; Centre Medical Seine (Jolin-Dahel), Ste. Anne, Man.; Seven Oaks Hospital (Appel), Winnipeg, Man.
Background:
Choosing Wisely Canada is an initiative to reduce overprescribing and overtesting. This study assessed adherence to 4 Choosing Wisely Canada recommendations for interventions commonly performed in primary care: (a) antibiotic prescriptions for infections that are probably viral in origin, (b) routine vitamin D tests in low-risk adults, (c) annual screening blood tests and (d) prescriptions of antipsychotic medication to treat symptoms of dementia.
Methods:
We conducted a retrospective cohort study of data from the electronic medical records of patients who had an encounter between 2014 and 2016 with a participating Manitoba Primary Care Research Network primary care provider in Manitoba, Canada. Patient encounter data were reviewed for prescribing and testing practices. Descriptive statistics and multivariable models assessed associations between patient and provider characteristics and rates of prescribing and testing.
Results:
Data for 164 195 patients from 230 providers were included in the study. Sixteen percent (n = 25 629) of patients had an encounter that involved potentially unnecessary diagnostic testing and treatment. A minority of providers contributed to above-average rates of prescribing and testing: 29% (n = 69) of providers prescribed antibiotics for a viral indication,11% (n = 24) prescribed an antipsychotic to a patient diagnosed with dementia, 9% (n = 24) ordered prostate-specific antigen tests and 14% (n = 34) ordered vitamin D tests at above-average rates, respectively. Patient and provider characteristics were associated with each of the prescribing and testing practices assessed.
Interpretation:
This study demonstrated that fewer than 30% of primary care providers contributed to interventions in direct contradiction to Choosing Wisely Canada recommendations. Improvement strategies specific to each prescription or testing recommendation should target specific providers to prevent patient harm and reduce unnecessary health care spending.
Insights
A minority of primary care providers in Canada overprescribed antibiotics and antipsychotics, and over-ordered tests, contradicting Choosing Wisely Canada guidelines. Targeted interventions are needed to reduce unnecessary medical care and spending.
Area of Science:
- Primary Care Research
- Health Services Research
- Medical Practice Improvement
Background:
- Choosing Wisely Canada aims to reduce overprescribing and overtesting in healthcare.
- The study focused on four key recommendations relevant to primary care interventions.
Purpose of the Study:
- To assess adherence to Choosing Wisely Canada recommendations in primary care.
- To identify rates of potentially unnecessary diagnostic testing and treatment.
Main Methods:
- Retrospective cohort study using electronic medical records from Manitoba, Canada (2014-2016).
- Analysis of prescribing and testing practices for 164,195 patients and 230 primary care providers.
- Descriptive statistics and multivariable models to assess patient and provider characteristics.
Main Results:
- 16% of patients encountered potentially unnecessary interventions.
- A minority of providers exceeded average rates for: antibiotic prescriptions for viral infections (29%), antipsychotic prescriptions for dementia (11%), PSA tests (9%), and vitamin D tests (14%).
- Patient and provider characteristics were associated with prescribing and testing practices.
Conclusions:
- Fewer than 30% of primary care providers contradicted Choosing Wisely Canada recommendations.
- Targeted improvement strategies are necessary for specific recommendations and providers.
- Interventions can help prevent patient harm and reduce healthcare spending.
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