Choose Wisely.

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Sabrina Scott
5 years ago
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of Family Medicine Director, Medical Decision Making Education

1 Choose Wisely Stephen A Wilson, MD, MPH, FAAFP Director, Faculty Development Fellowship University of Pittsburgh Dep t of Family Medicine Director, Medical Decision Making Education UPMC St Margaret Family Medicine Residency

2 Objectives 1. Describe Choosing Wisely 2. Name 3 Choose Wisely recommendation 3. Consider ways to implement Choose Wisely into their practice behaviors

3 Less is More

4 What is Choosing Wisely (CW)? Seeks to advance a national dialogue on avoiding wasteful or unnecessary medical tests, treatments and procedures

5 CW Aims 1. Supported by evidence 2. Not duplicative of other tests or procedures already received 3. Free from harm 4. Truly necessary

http://www.womentribe.com/wp-content/uploads/2011/11/sinusitis-300x243.

8 Don t routinely prescribe antibiotics for acute mild-tomoderate sinusitis unless symptoms last for seven or more days, or symptoms worsen after initial clinical improvement Sinusitis 16 million office visits $5.8 billion in annual health care costs

9 Institute for Clinical Systems Improvement (ICSI) guideline on diagnosis and treatment of respiratory illness in children and adults. National Guideline Clearinghouse 2013 May 20:43792 Symptoms to Consider Bacterial Sinusitis Upper respiratory symptoms for days AND 1 present for days facial or sinus pain aggravated by postural change fever purulent nasal discharge Other considerations worsening following initial improvement (double sickening) severe symptoms with fever 39 degrees C and purulent discharge for 3-4 consecutive days

10 Don t routinely prescribe antibiotics for acute mild-tomoderate sinusitis unless symptoms last for seven or more days, or symptoms worsen after initial clinical improvement Double Sickening Symptoms must include: discolored nasal secretions and facial or dental tenderness when touched Most sinusitis = viral infection resolve on its own Despite consistent recommendations to the contrary, Abx still prescribed >80% of outpatient visits for acute sinusitis

Cervical Cancer Screening (ASCCP & AAFP) Do not perform Pap smears on immunocompetent

vaginal cytology (Pap smears) or human papillomavirus (HPV) screening after a hysterectomy

(CIN 2/3) or cancer Avoid treatment of CIN 1 in women under age 25 http://www.

15 Cervical Cancer Screening (ASCCP & AAFP) Do not perform Pap smears on immunocompetent women younger than 21 Do not order screening tests for low-risk HPV types Do not perform vaginal cytology (Pap smears) or human papillomavirus (HPV) screening after a hysterectomy that included cervix removal, unless hysterectomy was for highgrade cervical dysplasia (CIN 2/3) or cancer Avoid treatment of CIN 1 in women under age

16 Cervical Cancer Screening (ASCCP & AAFP) Do not perform annual cervical cytology (Pap test) or annual HPV screening of immunocompetent women with a history of negative screening or who have had a hysterectomy for noncancer disease Do not screen women younger than 30 years of age for cervical cancer with HPV testing, alone or in combination with cytology Do not screen women older than 65 years of age for cervical cancer who have had adequate prior screening and are not otherwise at high risk for cervical cancer.

17 Less is More

Do not prescribe antibiotics for otitis media in children aged 2 12 years with non-severe symptoms where the observation option is reasonable Symptomatic relief Deferring Abx for 48 to 72 hours Child

18 Do not prescribe antibiotics for otitis media in children aged 2 12 years with non-severe symptoms where the observation option is reasonable Symptomatic relief Deferring Abx for 48 to 72 hours Child s age, diagnostic certainty and illness severity Ready means of communicating Reevaluation available

Do not use opioid or butalbital treatment for migraine except as a last resort Do not perform imaging of the carotid arteries for simple syncope without other neurologic symptoms Do not recommend CEA

19 Do not use opioid or butalbital treatment for migraine except as a last resort Do not perform imaging of the carotid arteries for simple syncope without other neurologic symptoms Do not recommend CEA for asymptomatic carotid stenosis unless the complication rate is low (<3%).

for low-risk patients without symptoms http://www.choosingwisely.

20 Do not screen for carotid artery stenosis (CAS) in asymptomatic adult patients. Do not order annual electrocardiograms (EKGs) or any other cardiac screening for low-risk patients without symptoms

23 Objectives 1. Describe Choosing Wisely 2. Name 3 Choose Wisely recommendation 3. Consider ways to implement Choose Wisely into their practice behaviors

24 References & Links New Guidelines for Cervical Cancer Screening Anna Wald, MD, MPH reviewing Moyer VA on behalf of the U.S. Preventive Services Task Force. Ann Intern Med 2012 Mar 14. Saslow D et al. Am J Clin Pathol 2012 Apr less=more - less is more - CW logo - ABIM logo - Aim higher - hands together in circle - Apple choice - dr-pt - dude, whoa - joey whoa - whoa gif - Cmmnctn - Cervix Exam - cervix cancer stages - otitis media - symptoms - KEY - climb guy - brain - thing 1

Cervical Cancer Screening

Cervical Cancer Screening MEGAN CHENEY, MD MPH MEDICAL DIRECTOR, THE WOMEN S CENTER ASSISTANT DIRECTOR, BGSMC OBGYN RESIDENCY PROGRAM SECTION CHIEF, THE WOMEN S HEALTH INSTITUTE Objectives Understand proper