Choosing Wisely is about providing good patient care by using the right tests and treatments at the right time. With over 500 recommendations across a large number of clinical specialties, and a selection of helpful patient resources, the amount of information can be overwhelming and hard to navigate.
Island Health’s Patient-Centred Public Awareness Communications Campaign brought together the patient perspective and provider expertise to identify potentially unnecessary low-risk tests and treatments.
Campaign goals:
- Promote conversation between patients and providers,
- Inform the public using accessible language on low-risk Choosing Wisely Canada (CWC) recommendations for tests and treatments that may not provide patient benefit, and
- Identify Choosing Wisely Canada as a trusted resource for information.
By increasing awareness and promoting conversations between providers and patients, we can help reduce unnecessary testing and treatments, and instead provide patients with the right tests at the right time.
Want to learn more about the campaign and opportunities for involvement? Expand the headings below or watch our short Campaign video to learn about the 11 Recommendations selected. If you would like to participate in the campaign please email MedStaffQI@islandhealth.ca.
We would love to hear from you about your experiences participating in this campaign, including any feedback you have for future improvements, and whether any of these recommendations become a part of your quality improvement journeys. Please email us at MedStaffQI@islandhealth.ca to discuss any aspect of this work.
- Campaign Overview – How did we get here?
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Inspired by the “Lessons from Creating a Thriving Choosing Wisely Program & Culture in a Community Hospital” presentation by Dr. Renato Pasqualucci and Dr. Charles Winegard at the Choosing Wisely Canada (CWC) National Meeting in May 2021, planning for our own Island Health version of a Choosing Wisely Patient-Centred Public Awareness Campaign began in summer 2021.
After consulting with multiple stakeholders to determine the best path forward a working group, whose membership prioritized equal representation of patients and providers, developed the campaign between January and July 2022. Following selection of the recommendations we have worked closely with Island Health Communications to develop campaign posters to share in offices island-wide, beginning with Island Health owned and operated sites including UPCCs and expanding as appropriate.
A special thank you to our Primary Care Campaign Working Group members: Annemarie Elderkin, Patient Partner; Bernie Lafrance, Patient Partner; Dr. Chris Kwiatkowski, Family Practice; Enise Olding, Patient Partner; Francesca Chiste, Nurse Practitioner, Family Practice; Fred Apstein, Patient Partner; Dr. Jennifer Oates, Geriatric Psychiatry; Dr. Louis- Philippe Plante, Emergency Medicine; Sarah Porter, Island Health; Susan Barr, Patient Partner; and Dr. Valerie Ehasoo, Geriatric & Youth, Primary Care
Physician participation the Working Group was funded through Health System Redesign. Project support, creation of materials including our campaign video, and an evaluation framework were developed in summer 2022 by Charuta Saha, BCPSQC Summer Student Intern.
- Eleven Recommendations for Primary Care
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Together our dedicated working group reviewed and short-listed low-risk CWC recommendations for potentially unnecessary tests or treatments while identifying key messages designed to appeal to the community. Our final eleven recommendations fit into three categories considering:
- Patient perspective by identifying tests and treatments that have broad appeal and ones where a patient has awareness.
- Provider perspective by highlighting recommendations that will enhance patient care and appeal to providers as frequently requested tests/treatments.
These eleven recommendations have been developed into posters that can be displayed in Community offices Island-wide. Please email MedStaffQI@islandhealth.ca to learn more or expand the heading “How to Participate?” below.
Want to learn more about resources available to support patient and provider conversation related to these recommendations? Expand the heading “Campaign Connections – How to search campaign resources using FPSC Pathways” below.
- Patient perspective by identifying tests and treatments that have broad appeal and ones where a patient has awareness.
- How to Participate?
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Both our community based and emergency department public awareness campaigns are about providing good patient care. Reducing frequency of less beneficial tests and treatments ensures these resources are more readily available when appropriate and meaningful. This also importantly helps reduce patient exposure to harm.
The key messaging for all selected recommendations focuses on promoting conversation between patients and providers.
Ultimately we aim to:
- Make conversation between patients and providers easier by laying groundwork.
- Achieve better outcomes for patients.
- Advocate for stewardship of resources to ensure the right test at the right time.
In partnership with Island Health Communications, the selected low-risk recommendations have been developed into posters to be shared in the community at Island Health owned & operated UPCCs, primary care offices, and emergency department waiting rooms island-wide.
Our goal is to have this valuable awareness campaign represented in all Island Health Consolidated Local Health Areas (CLHAs). If you are interested in displaying one or more campaign posters at your site, please email MedStaffQI@islandhealth.ca. All 11 primary care posters are viewable by expanding the “The Posters: Displaying the Recommendations in the Community” section below.
As the work grows we aim to share this information more broadly in external provider settings, using Island Health social media, and through the creation of a dedicated Island Health Choosing Wisely patient resource page on the public-facing website.
Click here to view a PDF of our Primary Care Campaign Overview
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The Posters: Displaying the Recommendations in the Community
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Digital files related to the recommendations are available for viewing and download using the links listed in the table below. The posters are optimized for printing on 11x17 paper.
If you would like to request a printed version be sent by mail please email MedStaffQI@islandhealth.ca to request your poster!
To help us evaluate the success of this campaign and collect feedback for future improvements, we ask that you let us know if you do print a poster to share in your office. We are hoping to track where the posters end up, and which recommendations are displayed at which sites.
Category
Campaign Recommendation
Poster Link
Medication Prescribing
Thorough medication reviews when prescribing new meds
Consider non-pharmacologic interventions for promotion of sleep
Consider risks & benefits of long-term medication use
Consider side effects & limitations of opioid prescribing
Lifestyle & Treatment Plans
Consider trigger management for migraines before imaging & prescribing
Imaging and prescribing for back pain w/out red flags may not be required
Bed rest should not be prescribed unless harm will result from activity
Work absences can contribute to declining health & slower recovery
Imaging & Routine Testing
Testing for Vitamin D deficiency is generally unnecessary
MRIs for hip/knees are not usually required when x-ray shows osteoarthritis
Ankle/foot x-ray may not be required for minor injuries
Click here to view a PDF Copy of all 11 posters using one link.
We would love to hear from you about your experiences participating in this campaign, any feedback you have for future improvements, and whether any of these recommendations become a part of your quality improvement journeys. Please email us at MedStaffQI@islandhealth.ca to discuss any aspect of this work.
- Campaign Connections – How to search campaign resources using FPSC Pathways
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Did you know that Choosing Wisely Canada has a number of Patient Pamphlets and resources available to help start the conversation about the risks and benefits of select tests and treatments?
These resources are available on the Choosing Wisely Canada website.
You can also find many of these helpful patient pamphlets using Family Practice Services Committee (FPSC) Pathways so they can be emailed to or printed for patients in real time as a conversation aid.
In the table below you will find:
- Links to Choosing Wisely Canada Patient Pamphlet where they are available.
- Suggested keywords to search to locate the Patient Pamphlets in FPSC Pathways.
Campaign Recommendation
Keywords to Search in Pathways
Link to Patient Pamphlet
Consider non-pharmacologic interventions for promotion of sleep
Sleep, bed, insomnia, antipsychotics, routine, routinely
https://choosingwiselycanada.org/pamphlet/sleeping-pills-and-older-adults/
Consider side effects & limitations of opioid prescribing
Opioid
Consider trigger management for migraines before imaging & prescribing
X-ray, headaches, migraine
https://choosingwiselycanada.org/pamphlet/treating-migraine-headaches/
https://choosingwiselycanada.org/pamphlet/imaging-tests-for-headaches/
Imaging and prescribing for back pain w/out red flags may not be required
Back, X, imaging, low, pain
https://choosingwiselycanada.org/pamphlet/imaging-tests-for-lower-back-pain/
Bed rest should not be prescribed unless harm will result from activity
Bed rest
*Just searching bed leads to sleep promotion methodshttps://choosingwiselycanada.org/pamphlet/treating-lower-back-pain/
Testing for Vitamin D deficiency is generally unnecessary
Vitamin D, vitamin, routine, routinely
MRIs for hip/knees are not usually required when x-ray shows osteoarthritis MRI, knee, hip, osteoarthritis No patient pamphlet resource, but you can find the Choosing Wisely Canada recommendation in Pathways by using the keywords listed. Ankle/foot x-ray may not be required for minor injuries Ankle, Foot, Ottawa, X-ray No patient pamphlet resource, but you can find the Choosing Wisely Canada recommendation in Pathways by using the keywords listed. Please note that three of our selected recommendations are difficult to locate in Pathways so we have linked the specific CWC recommendation attached to our campaign recommendation below:
- Thorough medication reviews when prescribing new meds
- Consider risks & benefits of long-term medication use
- Work absences can contribute to declining health & slower recovery
If you would like more information about the specific Choosing Wisely Canada recommendation that was used for the campaign please email MedStaffQI@islandhealth.ca. Some of the recommendations, for example “Consider the side effects & limitations of opioid prescribing”, are a combination of multiple CWC recommendations listed by multiple Specialties.
- Expansion to Island Health Emergency Departments
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At the recommendation of Island Health leadership, we are expanding the scope to develop public awareness materials featuring four Choosing Wisely Canada recommendations in emergency departments at Island Health.
In September 2022, four emergency department (ED) physicians representing four sites island-wide reviewed the 11 Primary Care Campaign recommendations alongside additional CWC ED recommendations to identify and prioritize low-risk tests and treatments that commonly present in the ED.
Their four chosen recommendations represent interventions commonly requested in the ED by patients. Sharing specific information about the recommendations will benefit patients and help set their expectations of what their treatment in the ED may include.
Our aim is to launch materials to promote these four recommendations in ED waiting rooms Island wide! This important work is in alignment with existing Island Health Communications campaigns aimed at educating patients on emergency room wait times and the triage process.
A special thank you to our ED working group participants: Dr. Louis-Philippe Plante, CDH; Dr. Neil Rogers, NRGH; Dr. Mike Thomson, RJH/VGH; Dr. Jason Wale, RJH/VGH; and Sarah Porter, Island Health.
Physician participation the Working Group was funded through Health System Redesign.
- Campaign Achievements
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We are pleased to share that the Choosing Wisely at Island Health Patient Centred Public Awareness Campaign has been recognized for its value throughout its development.
The campaign was featured twice at Health Quality BC (HQBC) Quality Forum as a Storyboard presentation, first in 2022 where we shared our Campaign Development Strategy and again in 2023 where Charuta Saha, our incredible 2022 HQBC Summer Student Intern presented our Proposed Evaluation Framework.
Choosing Wisely Canada also recognized our public awareness campaign as an innovative approach at the Choosing Wisely National Meeting in May 2022 where Dr. Adele Harrison and Sarah Porter were invited to present virtually during a Choosing Wisely Abstracts session.
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Local Linkages – Alignments with Island Health improvement work
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Along with the potential for site-based quality improvement in connection with campaign recommendations, there is also opportunity to leverage campaign posters to set expectations around patient requested tests that may not be ordered.
For example, the Island Health Medical Imaging department have launched a new MRI Appropriateness Checklist and updated MRI requisition form for community providers that is based off Choosing Wisely Canada guidelines for MRI ordering for shoulder, lumbar spine, knees/hips, and headaches. The new checklist and appropriateness criteria will aid in point of care decision making to determine whether MRI is appropriate.
To support this change in practice, sites may choose to display one of our three campaign posters related to MRI ordering to aid in patient-provider conversation, improving patient awareness of when imaging may not be required as part of the conversation toolkit.
Please visit the MRI Resource page to learn more about the MRI appropriateness guidelines and new process for community providers.
We invite you to email MedStaffQI@islandhealth.ca to request campaign posters if you would like to display one of our campaign posters related to MRI as this new process rolls out.
Click here to return to visit the Choosing Wisely MRI Resources page.
Ultimately our campaign and the recommendations are about promoting patient and provider conversations around appropriate care that benefits patients.
We hope that by providing trusted patient education resources in both the community and in emergency department waiting rooms we can empower patients as partners in their care and set expectations of when tests and treatments are appropriate.
We invite you to join our campaign! Email MedStaffQI@islandhealth.ca for more information.
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Click here to view a PDF of our Primary Care Campaign Overview |
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Click here to return to the main Choosing Wisely at Island Health webpage |