Choosing Wisely International and Japan - J-Stage

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May 28, 2015 - Dr. Wendy Levinson, who is Chair ... individual participating countries, Dr. Daniel Wolfson ... Dr. Levinson and Mr. Tai Huynh, Choosing Wisely.
General Medicine

2015, vol. 16, no. 2, p. 61–62.

Editorials

Choosing Wisely International and Japan Yasuharu Tokuda, MD, MPH Editor-in-Chief, General Medicine

The 2nd International Roundtable on Choosing Wisely

2. Share successful strategies and challenges to

was held in the Royal College of Anesthesiology Building, London, UK, on May 28–29, 2015 (Figure 1).

implementing Choosing Wisely. 3. Discuss approaches to evaluation of the campaign

This event was followed by the first such conference

and collaborate on common measures of overuse.

1

held in Amsterdam, Netherland. Since I had fortunate opportunity to participate in the 2nd international con-

Representatives from 17 countries participated in this meeting including two Asian countries (Dr. Hyeong

ference by courtesy of Dr Shunzo Koizumi (one of the former editors-in-chief of this journal), I would like to

Sik Ahn, Professor, Korea University College of Medicine, South Korea, and me from Japan). We also

report this exciting forefront for developing a rare but precious international medical campaign by advancing

had attendance by Mr. Niek Klazinga, a representative from the Organization for Economic Co-operation and

medical professionalism to improve health care pro-

Development (OECD), the Commonwealth Fund and

fessionalism. The purposes of the meeting were to:

the Consumer reports, USA. Dr. Wendy Levinson, who is Chair of the Choosing Wisely Canada, organized this meeting highly interactive and conversational (Figure 2, 3).

1. Share the progress that countries have made in Choosing Wisely over the last year.

After identifying major challenges to the campaigns in Figure 1. The Royal College of Anesthesiology Building, London, UK

individual participating countries, Dr. Daniel Wolfson introduced underlying principles of Choosing Wisely and its application to recommendations development and implementation by citing Self-Determination Theory and Complexity Theory enhancing cultural shifts in a society. In his remark, the USA Consumer Reports was identified an example of emergence among phenomena described by the complexity theory, since the Consumer Report was not initially expected as a major participant but it now provides strong and important role as consumers’ organization including various patient support groups for this campaign.

Corresponding author: Yasuharu Tokuda, MD, MPH JCHO, Tokyo, Japan E-Mail: [email protected] © 2015 The Japan Primary Care Association

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General Medicine

Figure 2. A scene of the meeting

2015, vol. 16, no. 2

Figure 3. Participants of the meeting

Figure 4. The workshop product of our discussion group

Table. Characteristics of Campaign Activities of Choosing Wisely USA and Canada Characteristic

Choosing Wisely USA

Choosing Wisely Canada

Starting year

2012

2014

Participating society

70 specialty societies

45 specialty societies

Recommendations

400

150

Patient pamphlet

90

25

Implementation

Organic and accelerated

Organic

Dr. Levinson and Mr. Tai Huynh, Choosing Wisely

to treat (NNT), which is calculated by 1/(absolute risk

Canada, showed their strategies and the challenges in their country compared to those in USA. Table shows

reduction). However, relative risk format misleads us to overestimate the treatment effect.2 Thus, we have

the most recent data showing campaign activities of

reached to conclude that medical journals should stop

Choosing Wisely USA and Canada. During the conference, we had open space session

using relative risk and start using absolute risk or NNT. In this journal, I should encourage clinical investigators

based on small group discussion for identifying issues and solutions related to choosing wisely campaign in

and educators to submit high-quality papers related to overuse of medical tests and interventions and also to

countries of participants. I had joined the discussion

provide their results data as absolute risk format to

group for issues about how to improve risk literacy among practicing physicians. In this discussion, we

follow the conclusion of our discussion group.

provided multiple examples of evidence showing how to improve health and risk literacy among physicians

References 1 Levinson W, Kallewaard M, Bhatia RS, Wolfson D,

(Figure 4).

Shortt S, Kerr EA: ‘Choosing Wisely’: a growing

One of these examples is a format in which randomized controlled trials or cohort studies present their results in

international campaign. BMJ Qual Saf. 2015;24(2): 167–174.

most medical journals. They usually present treatment effect as relative risk but adverse event rate as absolute

2 Bodemer N, Meder B, Gigerenzer G: Communicating Relative Risk Changes with Baseline Risk:

risk. Absolute risk is the preferred format for providing

Presentation Format and Numeracy Matter. Med Decis

clinically meaningful patient-centered information and this can be transformed easily into the number needed

Making. 2014;34(5):615–626.

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