POEMs are concise summaries of recent research studies that evaluate an outcome patients care about. They are sent by e-mail to Canadian physicians in a continuing medical education program sponsored by the Canadian Medical Association. After reading a POEM, physicians are asked to imagine how this information will affect their practices. One possible outcome is to use POEM information to decrease unnecessary tests, treatments, or referrals. Dr Grad analyzes POEM ratings received by the Canadian Medical Association from Canadian physicians. He believes these ratings provide a unique opportunity to give a “grass-roots” voice to the CWC campaign.
Choosing Wisely Canada: What made you decide to evaluate and analyze POEM ratings as they apply to Choosing Wisely?
Dr. Roland Grad: In my academic work, I analyze a mountain of data from the POEMs continuing medical education program—about 1300 completed questionnaires for each POEM. When I discovered the Choosing Wisely campaign, I saw a potential link: the POEM evaluation data reveal which tests or treatments are deemed “low value” by practising Canadian physicians. From these data, I then identified the top-rated POEMs of 2015 that were most consistent with the principles of Choosing Wisely.
CWC: How could POEMs be used to inform Choosing Wisely campaigns?
RG: I analyzed more than 300 000 POEM ratings (completed questionnaires) received in 2015. I then shared my findings with 2 organizations. First, I shared the 10 respiratory POEMs that had the highest ratings with the Canadian Thoracic Society as a way of informing their CWC list. Then, the editor of American Family Physician, the journal of the American Academy of Family Physicians, asked me to write a paper on the POEMs of 2015 that could inform conversations with patients in line with Choosing Wisely in the United States. This is exciting research—to see that national organizations are paying attention to what the “crowd” of physicians is saying. The crowd is telling us, based on POEMs and their practice wisdom, which tests, treatments, or procedures are low value.
CWC: What are your thoughts about how this work could go forward?
RG: Choosing Wisely Canada can publish lists of items to discuss with patients, but it does not mean they are going to be put into practice. What we need is the confidence to change our clinical practices when the evidence changes, and better tools, such as reminders built into electronic medical records (EMRs).
Some of the most highly rated POEMs of the past few years have pertained to respiratory infections and reducing the burden of antibiotics. An example of taking these higher-rated POEMs to the implementation level would be to put “Choosing Wisely reminders” into EMRs. For example, a reminder could suggest no prescription or a delayed prescription. Tools need to be built and shared. We need to partner with scientists and EMR companies to help us put research into practice in this way.
This article first appeared in Canadian Family Physician. The interview was prepared by Dr Kimberly Wintemute, Primary Care Co-Lead, and Hayley Thompson, Project Coordinator, for Choosing Wisely Canada.