Evidence That Drives Real Change

Authors: Wendy Levinson, Karen Born, Juan Victor Ariel Franco, Karin Silvana Kopitowski

Year: 2025

Abstract: Choosing Wisely campaigns are clinician-led efforts to raise awareness and develop interventions to reduce low-value health care. At the core of Choosing Wisely campaigns are lists of recommendations, developed by national clinician societies, of tests, treatments or procedures in their specialty for which there is excellent scientific evidence of overuse or harm to patients. First launched in the USA in 2012, Choosing Wisely campaigns have spread to over 35 countries globally and are present across all continents including Africa, South/Latin America and Asia.1 Yet despite increased awareness of the harms of low-value care, it remains stubbornly prevalent across health care systems globally.
Low-value care is common; up to 30% of all tests, treatments and procedures may be low value or even harmful to patients.2 For example, the chronic use of benzodiazepines or other sedative medications in older patients can lead to harm from falls and confusion and does not provide significant benefit for insomnia. Yet in Canada, 1 in 12 people over 65 years of age receives ongoing prescriptions for these medications. Through Choosing Wisely campaigns, national clinician societies develop lists of recommendations of common tests and treatments within the specialty, which are not supported by evidence and can expose patients to harm.
To continue to build momentum of Choosing Wisely campaigns and international collaborations related to deimplementation, we sought to develop a list of the most important clinical topics from all of the active Choosing Wisely campaigns globally. There is a need to develop system-level deimplementation approaches that are pragmatic and feasible, which can be implemented at the national or regional level.3 The publication of a shared international Choosing Wisely list can be the foundation for global collaboration to develop quality improvement interventions and to measure the impact of efforts to drive deimplementation and reduction of low-value care priorities across countries.

Authors: Karen Born, Wendy Levinson, Luis Claudio Correia, Sandra Vernero

Year: 2020

Abstract: The novel coronavirus (COVID-19) pandemic has brought forth issues of health system resource limitations into urgent matters of public importance. Our objective was to rapidly develop an international Choosing Wisely list of recommendations for clinicians and the public about using resources wisely in the COVID-19 pandemic. METHODS: Choosing Wisely Canada convened a rapid Delphi process to develop an international Choosing Wisely list for COVID-19. Informed by a rapid review of emerging literature, this process engaged a small group of clinicians and public advisors in Canada (n=10) and internationally (n=8) to develop a candidate list of recommendations. A survey with candidate recommendations was sent to Choosing Wisely clinician leaders in Canada and around the world. Based on survey results and input, list recommendations were modified. RESULTS: The survey was sent to 293 potential respondents and received a 56% response rate in 72 hours (n=163). Respondents were asked to score each of the 9 recommendations on a 5-point Likert scale ranging from 1 strongly disagree to 5 strongly agree followed by free text comment. There were 271 total comments across 9 recommendations. Overall, all 9 recommendations had high levels of agreement with 83%-96% of respondents ranking them as strongly agree or agree. INTERPRETATION: This list of recommendations provides evidence-based statements about using resources wisely in the COVID-19 pandemic. The list reflects international consensus on evidence-based recommendations for both clinicians and the public which were achieved through a rapid consensus building process. TRIAL REGISTRATION: n/a