Last year, the Hayes Blog reported about the Choosing Wisely campaign, a national initiative to identify unnecessary or overused medical tests and procedures and to promote evidence-based care. When first piloted, the Choosing Wisely campaign released 3 lists for physicians in internal medicine, family, and pediatrics.
Since then, Choosing Wisely has gained momentum as additional medical specialty organizations jumped onboard and developed their own lists. On February 21, 2013, the campaign released 18 new lists of specific, evidence-based recommendations for physicians and patients to consider. Each list provides information on when certain tests and procedures may be appropriate.
As an example, from the American Academy of Neurology:
- Don’t perform EEGs for headaches.
- Don’t perform imaging of the carotid arteries for simple syncope without other neurologic symptoms.
- Don’t use opioid or butalbital treatment for migraine except as a last resort.
- Don’t prescribe interferon-beta or glatiramer acetate to patients with disability from progressive, nonrelapsing forms of multiple sclerosis.
- Don’t recommend carotid endarterectomy for asymptomatic carotid stenosis unless the complication rate is low (
And from the American Academy of Family Physicians:
- Don’t do imaging for low back pain within the first 6 weeks, unless red flags are present.
- Don’t routinely prescribe antibiotics for acute mild-to-moderate sinusitis unless symptoms last for 7 or more days, or symptoms worsen after initial clinical improvement.
- Don’t use dual-energy x-ray absorptiometry (DEXA) screening for osteoporosis in women younger than 65 or men younger than 70 with no risk factors.
- Don’t order annual electrocardiograms (ECGs) or any other cardiac screening for low-risk patients without symptoms.
- Don’t perform Pap smears on women younger than 21 or who have had a hysterectomy for non-cancer disease.
Hayes has been reviewing the evidence and advocating evidence-based care for more than 2 decades. The Hayes Knowledge Center, our dynamic online library, now comprises evidence-based assessments and other information about more than 1,000 medical technologies, such as those on these lists. Additionally, Hayes provides custom evidence-based assessments and comparative effectiveness reviews for state and federal government healthcare programs, payers and providers. We applaud the Choosing Wisely campaign and its mission to help patients and physicians choose medical care based on sound evidence. Educating patients and providers about when and for whom certain medical tests and treatment should be administered is a necessary step toward reining in the out-of-control costs of medical care in the United States.