Choosing Wisely Canada has made over 450 recommendations about tests and treatments that should be avoided in certain clinical situations. However, many of these tests and treatments still occur because changing health care processes is not an easy task. Implementation science aims to understand the underlying reasons for health care processes and to develop and test potential solutions to improve them.

This project links Choosing Wisely Canada, patient, and health system partners in three provinces with leading Canadian implementation scientists to develop and test solutions for two important topics:

  • Imaging scans that are not needed for patients with low-risk back pain
  • Pre-operative tests that are not needed for patients having low-risk surgery

In each province, we have done preliminary studies to make sure we fully understand the different reasons for unnecessary care. We are now developing targeted solutions using insights from behavioural and system science that support both health professionals and patients to make informed decisions about whether these tests are needed. We will test these solutions in experiments. Some health organizations (either family practices for low back pain imaging or hospitals for pre-operative testing) will receive the solution and some will not. We will determine who gets the solution using an approach similar to flipping a coin to ensure that health organizations that receive or do not receive the solution are similar. We are working with the Canadian Institute of Health Information and other partners to use the data already routinely collected to measure whether the solution worked. If our solutions work, we will engage our partners to spread and scale them across Canada.

  • De- implementing wisely: developing the evidence base to reduce low-value care
  • De-Implementing Wisely Infographic

Patient Engagement

  • Operationalizing a patient engagement plan for health research: Sharing a codesigned planning template from a national clinical trial
  • The Do’s and Don’ts of Patient Partnership in Research – Infographic

Reducing Imaging for Low Back Pain

  • Barriers to reducing imaging for low back pain in Newfoundland and Labrador
  • Barriers to following imaging guidelines for the treatment and management of patients with low‑back pain in primary care: a qualitative assessment guided by the Theoretical Domains Framework
  • Patient education materials for non-specific low back pain and sciatica: a protocol for a systematic review and meta-analysis
  • Patient education materials for non-specific low back pain and sciatica: A systematic review and meta-analysis
  • Exploring perceived barriers and enablers to fidelity of training and delivery of an intervention to reduce imaging for low back pain: a qualitative interview study protocol
  • Exploring factors influencing chiropractors’ adherence to radiographic guidelines for low back pain using the Theoretical Domains Framework
  • What behaviour change techniques have been used to improve adherence to evidence-based low back pain imaging?

Reducing pre-operative testing

  • Protocol for assessing the determinants of preoperative test-ordering behaviour for low-risk surgical procedures using a theoretically driven, qualitative design
  • Barriers to reducing preoperative testing for low-risk surgical procedures: A qualitative assessment guided by the Theoretical Domains Framework

Antibiotic Use

  • Patient Perspectives of Upper Respiratory Tract Infections and How They Should be Managed
  • Physician-reported barriers to using evidence-based antibiotic prescription guidelines in primary care: protocol for a systematic review and synthesis of qualitative studies using the Theoretical Domains Framework

This research is funded by the Canadian Institutes for Health Research, Strategy for Patient Oriented Research Innovative Clinical Trial Grant (MYG-158642).