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Choosing Wisely Newfoundland and Labrador – One Year Later

Choosing Wisely Canada’s mission to help clinicians and patients engage in conversations about unnecessary care has expanded from coast-to-coast. Since the launch of our regional campaigns in 2016, a number of provinces and territories across Canada have launched locally-led campaigns.

Choosing Wisely NL launched in 2016, organized by Memorial University.  It was the first eastern province to officially join Choosing Wisely Canada’s regional campaigns.

Dr. Pat Parfrey, a clinician leader with Choosing Wisely NL, has emphasized that the campaign is focused on developing best-practices and guidelines on appropriate care in Newfoundland and Labrador. In conjunction with Quality of Care NL, Dr. Parfrey says the province is working towards ensuring “the right intervention is provided to the right patient at the right time.”

Changing Practices   

A barrier to reducing unnecessary care is changing existing practice patterns. It requires active engagement from clinicians to shift away from “this is what I’ve always done.”

Dr. Stephen Darcy is a family physician in Newfoundland and Labrador who has been involved with the Choosing Wisely NL campaign. Dr. Darcy immediately saw the value of the campaign in changing how clinicians and patients can reduce unnecessary testing.  However, he also admits that one of the biggest barriers to overcome was how we get this information to busy clinicians.

“Physicians are very keen to do the right thing. They want to be practicing using the most evidence-based approach. The problem is the amount of information we receive. You are competing for the attention of physicians who receive an overwhelming amount of information day-to-day.” says Dr. Darcy, “So if we send an email about our campaign, it may compete with another 30 emails that day.”

To overcome these barriers, Choosing Wisely NL has developed an academic detailing initiative that allows clinician leaders from Choosing Wisely to discuss overuse and unnecessary testing with other clinicians in their offices. Although Dr. Darcy says this can be more time consuming, it has become a powerful tool in communicating the Choosing Wisely message.

“We feel this method is very useful. It’s person to person. You get the clinician’s attention and allow them to discuss the challenges they have about tests or treatments in their own practice,” says Dr. Darcy, “It allows the campaign to get over the background noise and have a real discussion.”

Choosing Wisely NL plans to measure the impact of this initiative and hopes to expand it to more specialities across the province.

Changing the Conversation

The Choosing Wisely NL campaign priorities focus on areas where evidence overwhelmingly shows that a test, treatment or procedure provides no added value to patient care.

A report by the Public Health Agency of Canada found that in 2014, Newfoundland and Labrador was prescribing more antibiotics than any other province in Canada based on its size and population. The province dispensed 33% more antibiotics than Saskatchewan, the second highest user.

To address this, Choosing Wisely NL created patient and public resources to start a conversation about unnecessary antibiotic prescriptions. This included antibiotic awareness posters, physician prescription pads, and videos on the harms of antibiotic resistance.

Dr. Darcy says that he has noticed the benefit of the Choosing Wisely NL antibiotic campaign.

“Patients are more prepared to hear about why we don’t use antibiotics as a treatment option for certain scenarios. We are more open to having a dialogue about why we think this treatment is not appropriate.”

This has been an important step in reducing unnecessary antibiotic prescriptions in the province. Physicians in the province have noticed there is a difficult balance to overcome, between patient demand for antibiotics, and physicians feeling they need to fulfill this request. The NL campaign hopes that by communicating with both physician and patient groups, this will decrease the amount of unnecessary antibiotic prescriptions.

Next Steps:

In a year since the launch of Choosing Wisely NL, the campaign has successfully engaged patients and clinicians in conversations about unnecessary testing. Through developing resources and engaging clinicians at the local level, the campaign is continuously working towards changing practice in the province.

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