More care is not necessarily better care An initiative of the Council of Medical Colleges in New Zealand

It is a campaign to encourage conversations between health professionals and consumers/ patients and their whanau, so they :  Are informed by the evidence about possible tests, treatments and procedures.  Do not take part in tests, treatments and procedures which are unnecessary.  Are fully informed so they are able make the right choices for themselves. It is part of an international campaign …….

Choosing Wisely is a practical way of delivering on some aspects of the New Zealand Health strategy:  Emphasises a team approach multi health-professional examining their practice  Builds health literacy and two way engagement  Engages the consumer  Improves performance and outcomes  Improves quality of care  Targets where we spend

 Health practitioner led and patient focused  Evidenced based  About quality of care not cost savings – “more health care is not necessarily better care”  It is multi professional – engaging doctors, nurses, pharmacists and midwives and other health professional groups

 Care that gives little or no benefit to patients  Care where the risk of harm exceeds likely benefit  Care where the costs do not provide proportional benefit  To date, 17 groups in New Zealand have looked at the evidence and advice and developed 90 recommendations about tests, treatments or procedures health professionals should question.

 Do not request CT scans for lower back pain unless indicated by a validated clinician decision making tool  Only use antibiotics under certain circumstances  Not perform PSA testing for prostate cancer screening in men with no symptoms and whose life expectancy is less than 7 years.  Do not use antipsychotics as the first choice to treat behavioural and psychological symptoms of dementia  Do not prescribe benzodiazepines or other sedative-hypnotics to older adults as first choice for insomnia, agitation or delirium  Do not prescribe medication without conducting a drug regimen review  Ensure patients and families approaching end of life have a common understanding of the goals of care

1. Adopt recommendations by groups already involved in Choosing Wisely  These will be on the Choosing Wisely website 1. Develop you own list for your service area  Brainstorm at a meeting and consult peers, possibly by survey monkey  Ensure it is with the group’s scope of practice.  Refine to 5 or 6 tests, treatments or procedures that are: Used frequently May expose patients to harm May contribute to stress and avoidable cost for patients create an increased strain on our health care system. Have generally-accepted evidence to support each recommendation.

 Have consulted with HDC and HQSC consumer groups  Have two consumers on our steering group  Working with Consumer New Zealand o to prepare patient resources for the website o to survey consumer’s views o publish a consumer report  Will have patient information on our website

 Concentrate on the value of care  Change the culture of the delivery of some healthcare – “more is not always better”-a message for health professional and patients  Public engagement and education  Empower patients via the four questions: o Do I really need to have this test, treatment or procedure? o What are the risks o Are there simpler, safer options? o What happens if I do nothing?

 Clinician ◦ Diagnosis ◦ Aetiology ◦ Prognosis ◦ Treatment options ◦ Outcome probabilities  Patient ◦ Experience of illness ◦ Social circumstances ◦ Attitude to risk ◦ Goals, values, preferences ◦ Support needs

 New Zealand Medical Colleges  NZMA  Medical Council of New Zealand  Pharmaceutical Society  Midwives Colleges  Cochrane New Zealand and many others And is funded by  HQSC  Ministry of Health  Other sponsorships and funders or help in kind is being sought

Website launch – 7 December 2016 Implementation workshop – April 2017 For more information contact  in Australia  in Canada  in the USA Thank you