Assessing equity in Choosing Wisely

Researcher Anna Adcock (Ngāti Mutunga) also attended some of the Preventing Overdiagnosis conference. With Choosing Wisely clinical lead Dr Derek Sherwood, advisory group member and emergency physician Dr John Bonning, and Dr Guylene Theriault from Choosing Wisely Canada, she helped facilitate a workshop focused on Choosing Wisely and equity.

As part of the workshop, she presented on a piece of research she is undertaking for the New Zealand Council of Medical Colleges, which sponsors Choosing Wisely in New Zealand, and Te Ohu Rata o Aotearoa (Te ORA) – the Māori Medical Practitioners Association. The research explores Māori views on Choosing Wisely and shared decision-making. Ms Adcock will make recommendations on how Choosing Wisely could be implemented in a way that better meets the needs of Māori and is more equity focused.

“Choosing Wisely originated in America and was introduced in Aotearoa in 2016 – but there hasn’t been an equity focus,” she says. “The Council of Medical Colleges and Te ORA identified that there was a real need to address this in Aotearoa, where we function under the Treaty of Waitangi. We know that programmes with a ‘one size fits all’ approach don’t work, and can risk increasing inequity.”

She says the Choosing Wisely campaign has the potential to increase inequities, because of its focus on overuse of testing and treatments.

“Rather than being over tested or treated, Māori are more often under-served by our health system, not receiving adequate or equitable care.”

She is leading a qualitative project called ‘Choosing Wisely means choosing equity’, talking to Māori whānau (as consumers of health care) and Māori health professionals from a range of professions, including general practice, nursing, midwifery and pharmacy.

“I am asking about their views on Choosing Wisely as a campaign, and whether they see value in it for Māori. This includes talking about shared decision-making – what makes a good environment for it, and how Choosing Wisely as a campaign could promote it.

“We are covering things like whether the Choosing Wisely resources are appropriate for Māori, if consumers or health professionals see any potential barriers for the campaign, and whether there could be a greater equity focus for Māori.”

Anna Adcock will present her report at the New Zealand Choosing Wisely forum on 1 May 2020 in Wellington.

She says there appears to have been limited work undertaken internationally looking at equity issues related to the Choosing Wisely campaign.

“It’s great that the Council of Medical Colleges and Te ORA are undertaking this research, and I hope that other nations will do the same.”