The Choosing Wisely campaign is consulting on Choosing Wisely recommendations for Pharmacy in NZ

What is Choosing Wisely?

The Choosing Wisely campaign aims to promote a culture where low value and inappropriate clinical interventions are avoided, and patients and health professionals have well-informed conversations around their treatment options, leading to better decisions and outcomes.

Choosing Wisely encourages consumers and health professionals to discuss whether a particular test, treatment or procedure is needed. Tests, treatments and procedures have side-effects and some may even cause harm. For example, CT scans and x-rays expose people to radiation; overuse of antibiotics leads to them become less effective; a false positive test may lead to painful and stressful further investigation. Choosing Wisely is working to decrease low value care, improve shared decision making and increase quality of care for all.

Choosing Wisely means Choosing Equity

Although the NZ health system acknowledges Te Tiriti o Waitangi principles of partnership, participation, and protection, and aspires to health equity, Māori experience highlighted inequities in health outcomes, mortality, health care access, and satisfaction with health services.

As Choosing Wisely is adopted, care must be taken to ensure that the ‘do less’ aim does not increase existing inequities for Māori. For example, Māori children and adults are more likely (than non-Māori) to experience unmet need for primary health care, including not being able to get an appointment at their usual medical centre within 24 hours, or to miss out on prescription medication because of cost. Māori also tend to receive fewer tests and referrals. During consultations, Māori are less likely to get
satisfactory answers when they do ask questions, less likely to have things explained to them well, and less likely to feel listened to by health professionals. Health campaigns, such as Choosing Wisely New Zealand, must be careful to not exacerbate these existing inequities.

Therefore, Choosing Wisely has commissioned a report Choosing Wisely means Choosing Equity to develop an in-depth understanding of Māori health consumers and health providers/practitioners’ perspectives on shared decision-making, and make recommendations for a more equity focused Choosing Wisely campaign.

Why do we have Choosing Wisely recommendations?

To engage health professionals, Choosing Wisely encourages groups of health professionals to identify tests, treatments, and procedures healthcare professionals, patients and consumers should question in their scope of practice. Each recommendation is based on the best available evidence. These recommendations are not prescriptive but are intended as guidance to start a conversation with patients about what is appropriate and necessary. As each situation is unique, healthcare professionals and patients should use the recommendations to collaboratively formulate their own healthcare plan together.

In NZ we now have over 150 recommendations on our website https://choosingwisely.org.nz/health-professionals/ from a wide range of professions. These recommendations are periodically reviewed, updated and extended. In many areas professional groups have taken the recommendations and implemented Choosing Wisely projects. In June 2020 there is a commitment to the Choosing Wisely campaign from 18 district health boards (DHBs) who have been or are involved in over 100 Choosing
Wisely projects. For more information on Choosing Wisely work over the last four years see https://choosingwisely.org.nz/choosing-wisely-in-aotearoa-new-zealand-the-achievements-and-the-challenges/.

Choosing Wisely and pharmacy

In 2018, after Choosing Wisely presentations at various meetings of pharmacy managers, professionals working in PHOs and DHBs; a group of pharmacists from all areas of the profession opted in to work together to develop Choosing Wisely recommendations relevant for pharmacy. Since 2018 more than 40 pharmacists have been involved, including hospital pharmacists, those working in primary care and community pharmacists.

It was agreed that the group should look at areas where pharmacists could make a difference i.e. recommendations that impacted on the way they worked or where they could have impact on others (pan-professional). The aim was to identify recommendations that would impact across all the areas pharmacists worked.

New recommendations also need to meet Choosing Wisely criteria, that is they must be developed through a transparent and documented process, and involve interventions which:

  • are within the group’s scope of practice
  • are used frequently
  • may expose consumers to harm and/or may contribute to stress and avoidable cost for consumers
  • when implemented, will not increase inequity
  • are supported by generally accepted evidence.

Initially the group reviewed recommendations from other pharmacy groups world-wide and narrowed these down to ones that would work and have an impact in NZ and supplemented these with possible NZ recommendations. These were further developed by a small working group who reduced the initial long list to five recommendations relevant for pharmacy professionals in NZ, researched the evidence base for these and reviewed the appropriateness of the criteria and wording.

The proposed Choosing Wisely recommendations for pharmacy in NZ (attached) cover: the treatment of gout; complementary medicines; the “triple whammy”; dispensing opioids with laxatives; and when to do in-pharmacy point of care testing. Work has also started to identify patient resources that match the recommendations.

The working group would now like to share these proposed five recommendations with the wider pharmacy profession in NZ, for consultation.

 Do you agree with these recommendations and if not why not?

Please note we are not seeking ideas for new recommendations at this stage in the process, but rather comments to strengthen/improve the final five?

The draft recommendations are attached as follows:

1. Choosing Wisely_Pharmacy_CAM

2. Choosing Wisely_Pharmacy_Gout

3. Choosing Wisely_Pharmacy_Triple Whammy

4. Choosing Wisely_Pharmacy_Opioids and laxatives

5. Choosing Wisely_Pharmacy_Opportunistic Testing

Please review these recommendations and send any comments to: enquiries@cmc.org.nz by 24 August 2020

Sue Ineson –Choosing Wisely Facilitator | Council of Medical Colleges
PO Box 10375
Email: sue.ineson@cmc.org.nz Ph: Cell: 021 608 039| Website www.cmc.org.nz