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The campaign “Doing more does not mean doing better – CHOOSING WISELY ITALY”
It aims to help physicians, other health professionals, patients and citizens engage in conversations about tests, treatments and procedures at risk of inappropriateness in Italy, to arrive at informed and shared choices.
The campaign is based on the responsibility of physicians and other health professionals and on the participation of patients and citizens
RECOMMENDATIONS
Tests, treatments and procedures at risk of inappropriateness in Italy that physicians, other health professionals, patients and citizens should talk about.
SOCIETIES
Italian Scientific Societies and Professional Associations that have defined the recommendations
CITIZENS
Section for patients and citizens
YOUTH CWIt
Choosing Wisely Italy for students and physicians in training
NEWS FROM THE WORLD
Choosing Wisely International Roundtable in Barcelona
Choosing Wisely International Roundtable 2024 took place in Barcelona on 9 and 10 October, coordinated by Canada and attended by representatives from more than 20 countries around the world.
The international meeting was attended by Sandra Vernero, Marika Werren (Slow Medicine/Choosing Wisely Italy), Paolo Francesconi (Regional Health Agency of Tuscany) and Chiara Marini (University of Florence) for Italy.
Sandra Vernero gave a presentation entitled Climate Sustainability Work in Choosing Wisely Italy, which addressed the issues of Green Choosing Wisely and green recommendations and illustrated the Italian project to raise awareness among professionals and citizens about the damage caused by plastic and to reduce its use in the healthcare sector as well as the project of the city of Bergamo to improve environmental sustainability.
Chiara Marini presented the de-implementation project of the Regional Health Agency of Tuscany, coordinated by Paolo Francesconi, aimed at reducing unnecessary prescriptions of health services.
The following topics were discussed in the meeting.
• Climate sustainability and appropriateness of care
• Research on de-implementation: state of the art and future prospects
• Approaches to promote patient involvement
Dedicated sessions were organized for each topic, in which the projects and initiatives promoted by the various countries were presented and working groups were organized to explore new ideas, analyze opportunities and reflect on the critical issues to be addressed.
Multinational survey on low value care among primary care physicians
The results of the multinational primary care survey defined within the Choosing Wisely International network, the University of Helsinki and the Finnish Medical Society Duodecim have been published:
Perspectives on low-value care and barriers to de-implementation among primary care physicians: a multinational survey (BMC Primary Care, biomedcentral.com).
The survey, aimed at primary care physicians, intended to explore attitudes towards low-value care and identify the most important barriers to the de-implementation of low-value care use in primary care in high-income countries. It was carried out through an online questionnaire regarding: knowledge of Choosing Wisely recommendations, attitudes towards overdiagnosis and overtreatment, barriers to deimplementation of low value care.
Six high-income countries participated: Austria, Finland, Greece, Italy, Japan and Sweden. Differences have emerged among different countries.
According to the article’s conclusions, more than 80% of primary care physicians consider overtreatment and overdiagnosis as a problem in their country’s healthcare but fewer (around 50%) in their own practice. Lack of time, fear of error, and patient pressures are common barriers to de-implementation in high-income countries and should be acknowledged when planning future healthcare. Due to the wide variety of barriers to de-implementation and differences in their importance in different contexts, understanding local barriers is crucial when planning de-implementation strategies.
For Italy, the Regional Health Agency of Tuscany (ARS) participated with Paolo Francesconi and Benedetta Bellini; Slow Medicine/Choosing Wisely Italy, with Paola Mosconi and Sandra Vernero, contributed to the research.
Choosing Wisely International Roundtable in Oslo
At the Choosing Wisely International Roundtable in Oslo on 11 and 12 September 2023, Sandra Vernero from CW Italy and Paolo Francesconi from Regional health agency of Tuscany participated for Italy.
The two main topics were the implementation of the recommendations and the environmental sustainability. In this regard, Sandra Vernero’s presentation “Towards a Green CW Italy” and the Italian “green” recommendations aroused interest.
As regards the implementation of the recommendations, international experiences were discussed and examples can be drawn.
Working groups have been established on Planetary Health and on the implementation of the recommendations of which Italy is part.
The results of two surveys in which Italy participated with the Tuscany region were presented: one on primary care doctors and low clinical level care, coordinated by Finland, and one on overuse in pediatrics by the European Academy of Pediatrics.
It was also decided to produce a 2-monthly newsletter to communicate Choosing Wisely’s activities and publications around the world and to hold an international webinar that will take place 3-4 times a year on Tuesday at 5:30pm CET, duration 1 hour.
A new book titled How to reduce overuse in Healthcare: A Practical Guide was recently published by Choosing Wisely international colleagues and presented in Oslo Roundtable. Edited by Drs. Tijn Kool, Andrea Patey, Simone van Dulmen, and Jeremy Grimshaw, this book provides a 5-step evidence- and theory-based framework for developing an evaluation program to reduce low-value care. How to reduce overuse in Healthcare: A Practical Guide is designed to provide practical guidance and tools for healthcare providers, their professional societies and policy makers developing programs to de-implement low-value or unnecessary care and improve patient.
Website: https://www.wiley.com/en-ca/How+to+Reduce+Overuse+in+Healthcare%3A+A+Practical+Guide-p-9781119862727
Contact: tijn.kool@radboudumc.nl
NEWS FROM ITALY
“Choosing Wisely Italy: a tool to improve the appropriateness and quality of care” Distance learning course
From Monday 4 March 2024, the new distance learning course of the National Federation of Medical Doctors’ and Dentists’ Orders (FNOMCeO) “Choosing Wisely Italy: a tool to improve the appropriateness and quality of care” is available free of charge for Italian doctors and dentists and provides 10 credits in Continuing Medical Education (CME code 411717).
It will be possible to follow the course until at least 31 December 2024.
The course was created by the Slow Medicine ETS association and the Choosing Wisely Italy campaign to help physicians provide appropriate prescriptions for tests, drugs, other treatments and procedures, in alliance with patients and citizens.
The objective of the course is the dissemination of knowledge on the topics of clinical appropriateness and the overuse of tests, treatments and procedures, on Choosing Wisely, the Choosing Wisely Italy campaign and its Green evolution, as well as on some recommendations of general medical interest.
Interventions that improve clinical appropriateness act positively on several aspects of the quality of care: they increase professionals’ adherence to the best scientific knowledge (practical effectiveness), they decrease adverse events associated with care (safety), they shorten waiting lists (equity, accessibility) and reduce waste of resources (efficiency). Also they improve the doctor-patient relationship (perceived quality) and last but not least they limit greenhouse gas emissions and the impact on the environment resulting from healthcare (ecological footprint).
The course includes 10 video presentations, 5 exercises on 25 daily practice cases and a CME questionnaire that investigates the knowledge acquired.
New recommendations ISDE for a Green General Practitioner
After the launch of Green Choosing Wisely (CW) Italy at the June 2022 conference at the IRCCS Mario Negri in Milan in collaboration with ISDE – Doctors for the Environment, ISDE presented 5 recommendations for a Green General Practitioner, developed by the ISDE Young Working Group.
In this list the invitation addressed to General Practitioners is to reduce the ecological footprint of healthcare services:
– reducing unnecessary tests and medications, in the logic of Choosing Wisely
– limiting practices that cause damage to the environment (spray inhalers for asthma and COPD and printed medical prescriptions)
– but also by reducing the demand for healthcare services through the dissemination of correct lifestyle habits and enhancement of health.
New recommandations for Green Choosing Wisely Italy on Green Endoscopy
AIGO (The Italian Association of Hospital Gastroenterologists and Digestive Endoscopists) after having published a position paper and structured other awareness-raising initiatives on the responsibility of professionals towards climate change, defined within the AIGO GREEN path 5 recommendations for Choosing Wisely Italy on Green Endoscopy
https://choosingwiselyitaly.org/wp-content/uploads/2023/04/Scheda-AIGO-Green-engl.pdf
An article on the subject, signed by Francesco Bortoluzzi and Sandra Vernero, was published by Quotidiano Sanità
Endoscopy Green? Yes you can, here’s how
The five AIGO recommendations on green endoscopy are fully part of the recent initiative of a GREEN CHOOSING WISELY, launched in collaboration with the ISDE association of Doctors for the Environment, which intends to raise awareness among professionals and citizens on the fact that the reduction of unnecessary practices can be an advantage both for people’s health and for the environment. Professional societies are invited to:
– develop recommendations on practices that cause harm to the environment
– describe the environmental consequences of inappropriate practices.
Other scientific societies are defining “green” recommendations for their area of expertise.
PARTNERS
