A survey of primary care patients' readiness to engage in the de-adoption practices recommended by Choosing Wisely Canada.
BACKGROUND
Strategies such as Choosing Wisely have been established to identify the overuse of interventions considered as low-value. Reduction of low-value practices will require patients to understand why certain interventions are no longer recommended. The objective of this study was to determine whether older adults accept the rationale for and perceive themselves ready to de-adopt annual electrocardiogram testing, imaging for low back pain, the use of antibiotics for sinusitis, the use of sedative-hypnotics for insomnia, and the use of antipsychotics to treat behavioural symptoms of dementia.


METHODS
A self-administered iPad survey was distributed to consecutive patients aged 50 years and older, presenting to three primary care outpatient practices in Ontario, Canada. Data from patients who were able and willing to complete the survey while waiting to see their physician were included. The survey queried knowledge, attitudes and behaviours around the targeted low-value interventions, before and after exposure to a Choosing Wisely Canada patient educational brochure on one of these five topics. A subset of patients agreed to participate in a semi-structured interview after their clinic visit.


RESULTS
Three-hundred and forty-four patients (mean age 63, range 50-88, 59 % female) read the materials and completed the survey. Forty-eight percent (95 % CI 43-53 %) intended to discuss the information with a healthcare provider. Forty-five percent (95 % CI 40-51 %) expressed a desire to change current low-value practices. Approximately two-thirds of those who indicated they would not change future behaviours explained that it was because they were already espousing the Choosing Wisely values. After reading the Choosing Wisely brochures, knowledge improved independent of age, sex and education in 48 % (95 % CI 38-57 %) of participants about electrocardiogram testing, in 74 % (95 % CI 65-82 %) about use of antipsychotics, in 66 % (95 % CI 52-78 %) about use of antibiotics for sinusitis, in 60 % (95 % CI 46-72 %) about imaging for low back pain, and in 40 % (95 % CI 26-55 %) about sedative-hypnotic use in the elderly.


CONCLUSIONS
The majority of primary care patients seem ready to de-adopt low-value practices. Provision of education in clinic waiting rooms can help improve knowledge around unnecessary care.
Faculty of Medicine, Department of Medicine, University of Toronto, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.
William
W
Silverstein
Faculty of Medicine, Department of Medicine, University of Toronto, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.
Elliot
E
Lass
Faculty of Medicine, Department of Medicine, University of Toronto, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.
Karen
K
Born
Centre de Recherche, Institut Universitaire de Gériatrie de Montréal, Université de Montréal, Montréal, QC, Canada.
Anne
A
Morinville
Faculty of Medicine, Department of Medicine, University of Toronto, 30 Bond Street, Toronto, ON, M5B 1W8, Canada. wendy.levinson@utoronto.ca.
Wendy
W
Levinson
Faculty of Medicine, Université de Montréal, Montréal, QC, Canada.|Faculties of Medicine and Pharmacy, Université de Montréal, Montréal, QC, Canada.
Cara
C
Tannenbaum
D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D002170:Canada; D002755:Choice Behavior; D005260:Female; D019538:Health Care Surveys / Q000379:methods / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D000069342:Medical Overuse / Q000517:prevention & control; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D010353:Patient Education as Topic / Q000379:methods; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000379:methods / Q000706:statistics & numerical data*
Choosing Wisely; Health literacy; Patient educational materials; Shared-decision making