Choosing Wisely

There are “Choosing Wisely” campaigns to combat the overuse of health care in more than 20 countries. In each country, campaigns partner with national clinician societies to making recommendations about unnecessary and commonly overused medical practices that can harm to patients.

Choosing Wisely Australia is an initiative of NPS MedicineWise, who provide evidence-based information and tools to improve appropriateness and quality of prescription medicines in Australia.

Long-term benzodiazepine use in older adults leads to significant harm, increasing risks of car accidents, falls and fractures, hospitalization, and death.

Reducing unnecessary proton pump inhibitors (PPI) use for heartburn is featured on a number of national specialty society lists for the Smarter Medicine Switzerland campaign.

Luis Correia, M.D., a cardiologist and leader of the Choosing Wisely Brazil campaign, estimates that up to 80 percent of the echocardiograms ordered in the private health system are unnecessary.

The Choosing Wisely Canada Geriatrics and Psychiatry lists of recommendations include avoiding unnecessary antipsychotics for elderly adults. Antipsychotics should only be prescribed to treat behavioral symptoms of dementia when other strategies have failed. Long-term use of antipsychotics in elderly patients has significant harms and side effects, such as increasing risks of confusion, falls, pneumonia and delirium.

National clinician societies in Canada representing anesthesiologists, cardiologists, surgeons, and transfusion specialists recommend not performing regular preoperative testing for healthy patients before minor surgery.

Older adults commonly have bacteria present in their urine, a condition known as bacteriuria. Clinicians and patients often assume that this is a sign of a urinary tract infection requiring antibiotics. However, if patients have no other symptoms, such as fever or a burning sensation when urinating, they do not need antibiotics. Unnecessary use of antibiotics leads to antimicrobial resistance and can have very harmful side effects like kidney failure and antibiotic-related diarrhea.

When hospitalized patients have a urinary catheter, it can reduce mobility and lead to catheter- associated infections. Evidence suggests that urinary catheters are often inserted when not needed for hospitalized inpatients.