Choosing Wisely Campaign Builds Momentum

Am J Manag Care. 2016;22(7):495-496

As recognition of Choosing Wisely’s influence in leading a national dialogue on reducing waste has grown, many have sought to determine physicians’ awareness of the campaign and acceptance of the specialty society recommendations. The paper published by Colla et al¹ in the May 2016 issue of The American Journal of Managed Care is a welcome contribution to this body of knowledge; yet, as the authors acknowledge, it is not without limitations.

It is promising that a survey conducted in January 2014, less than 2 years after the launch of the campaign, found about 47.2% of primary care physicians and 37.4% of specialists at Atrius Health reported awareness of the Choosing Wisely campaign. This is in line with a survey commissioned by the ABIM Foundation and supported by the Robert Wood Johnson Foundation fielded at about the same time that found 45% of primary care physicians and 33% of specialists nationwide said they were aware of Choosing Wisely.² The differing rates of awareness among primary care versus specialists found in both surveys is to be expected, as primary care groups were among the early adopters of Choosing Wisely, with specialist groups joining later. These rates of awareness are quite good and demonstrate that physicians are receptive to the campaign’s messages.

It was also heartening to see that even in the early stages of Choosing Wisely, the authors found widespread acceptance of the society recommendations, with 97.1% of primary care physicians saying they were legitimate sources of guidance. Going a step further, the authors found 75.1% of primary care physicians said the campaign empowered them to reduce unnecessary tests or procedures. These are important signals that Choosing Wisely’s approach of autonomy and self-regulation resonates with physicians and supports them in their conversations with patients about what care is best for them.

Unfortunately, the lengthy gap between the completion of the survey and the publication of its results means the levels of awareness likely do not reflect the current state. The Choosing Wisely campaign is now entering its fifth year, and has been incredibly active since the surveys were fielded. Many more society partners have joined the campaign and published recommendations—now totaling more than 450. Societies have engaged their members in communications and educational activities, helping to increase their awareness and adoption of Choosing Wisely in their practice.

About a year ago, the ABIM Foundation’s first cohort of 21 grantees—supported by the Robert Wood Johnson Foundation (RWJF)—completed their projects aimed at educating physicians about the society recommendations and building skills to help them have conversations with patients about the care they need.

Thanks to a second round of funding from RWJF, in 2015, 7 new multi-stakeholder initiatives were launched that focus on at least 3 Choosing Wisely recommendations, including reducing the use of antibiotics for viral infections by at least 20% over nearly 3 years at participating health systems, hospitals, and medical groups in their regions.

Earlier this year, we announced that 20 societies will participate in the Choosing Wisely Champions program to recognize their members who are making significant contributions to advancing the campaign. The American Geriatrics Society has already announced that 2 of its members have received this award and will be recognized at their annual meeting.

As the number of campaign partners and activities has grown, we believe awareness of Choosing Wisely, as well as physicians’ comfort level in engaging conversations with their patients, has increased beyond what is reported in the authors’ article—particularly in areas where local efforts are underway. To date, thousands of media articles have been published, along with hundreds of journal articles about the campaign and society recommendations, and millions have visited the Choosing Wisely website and accessed information for clinicians and patients.

Another concern of this study relates to the author’s juxtaposition of Choosing Wisely awareness with physicians’ attitudes about cost-consciousness in medicine. Since its inception, Choosing Wisely has explicitly focused on conversations aimed at reducing waste and avoiding patient harm. But given the undeniable relationship between eliminating unnecessary care and reducing costs, it’s unsurprising that some have suggested “financial stewardship” should be included in its goals.

We know from our research that physicians believe they are in the best position to address unnecessary care with their patients, but react negatively to the notion that they should be responsible for reducing costs of care. Physicians are in a better position to mitigate the use of tests and treatments they order. Although Colla et al report that many physicians said they have a responsibility to control costs, at this time they don’t have the necessary tools (ie, prices of tests and procedures) nor supporting communication skills to have informed discussions with their patients in this area.

Through the leadership of specialty societies and publication of recommendations, Choosing Wisely gives clinicians the autonomy to make informed decisions with their patients about appropriate care. Tools and resources from the campaign, such as freely available communications skills modules, help support clinicians in engaging their patients in these conversations.

As the campaign enters its fifth year, we are optimistic about its future. New society partners representing additional spheres of healthcare are joining—including pharmacy and dentistry—and existing partners are publishing second, and in some cases, third lists of 5 overused tests and treatments. Additionally, our 7 grant projects are beginning to see the fruits of their labor in reducing inappropriate use of antibiotics and other specialty recommendations.

I recently heard a presenter share that “Choosing Wisely” was now shorthand for eliminating unnecessary care at his institution. Choosing Wisely is entering our shared lexicon for understanding what it means to deliver only the most appropriate care. This gives us optimism that the hard work of our many partners is paying off and the messages of Choosing Wisely are not only reaching, but are being embraced, by clinicians and patients nationwide.

Acknowledgments

The author would like to acknowledge John Held for his contributions to this article.

Author Affiliation: ABIM Foundation, Philadelphia, PA.

Source of Funding: None.

Author Disclosures: The author reports no relationship or financial interest with any entity that would pose a conflict of interest with the subject matter of this article. Mr Wolfson is a member of the Editorial Board of The American Journal of Managed Care.

Authorship Information: Concept and design; drafting of the manuscript; critical revision of the manuscript for important intellectual content.

Address correspondence to: Daniel B. Wolfson, MHSA, ABIM Foundation, 510 Walnut St, Philadelphia, PA 19106. E-mail: DWolfson@ABIM.org.

REFERENCES

1. Colla CH, Kinsella EA, Morden NE, Meyers DJ, Rosenthal MB, Sequist TD. Physician perceptions of Choosing Wisely and drivers of overuse. Am J Manag Care. 2016;22(5):337-343.

2. PerryUndem Research/Communication. Unnecessary tests and procedures in the health care system. Choosing Wisely website. http://www.choosingwisely.org/wp-content/uploads/2015/04/Final-Choosing-Wisely-Survey-Report.pdf. Published May 1, 2014. Accessed June 2016.

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