1. Alberta Medical Association
Low Back Pain
Presentation
Prepared By:
Alberta Medical Association
December 9, 2015

2. Objective Describe Choosing Wisely unique value.
Provide overview of More Is Not Always
Better patient campaign
Highlight Low Back Pain as a priority topic, with a call to action!

3. In partnership with the Canadian Medical Association, a campaign to help physicians and patients engage in conversations about unnecessary tests, treatments and procedures, and to support physician efforts to help patients make smart and effective choices to ensure high-quality care.
These conversations with patients are critical to avoiding harm as well as focusing on the right care practices.
The AMA is taking the lead to coordinate this initiative with our Alberta partners.

4. “More Is Not Always Better”
Choosing Wisely is a physician-driven campaign to promote healthy patient and physician conversations about tests, treatments and procedures.
Choosing Wisely Canada recognizes the importance of educating and engaging patients so that they could make informed choices about their care. This campaign has created patient-friendly materials to help patients learn about the tests, treatments or procedures in question, when they are necessary and when they are not, and what patients can do to improve their health. Choosing Wisely Canada is working with various stakeholder groups to disseminate the patient materials widely.

5. Patient Poster Campaign
This poster campaign uses metaphor to show that in health, as in life, More is Not Always Better. It is intended to counter-act the pervasive belief that more testing means better care.

6. More Is Not Always Better
A 30 second silent video which can be played on waiting room TV screens.
(hover the cursor over the image to start to video) 6

7. Since April of 2014 ….
161 recommendations to date
27 national societies published to date
28 patient pamphlets published to date

8. Patient Communication
More is not always better philosophy and approach
62% of Canadians agree that there is a significant amount of unnecessary care in the health care system
92% of Canadians believe patients need more support to know which services are really necessary for their health
68% of Canadian family physicians agree that more tools are needed to help them make decisions about which services are inappropriate for their patients
Since the launch of Choosing Wisely Canada in April 2014, significant effort has gone into educating physicians and mobilizing the health care provider community to adopt the published recommendations. And these efforts are beginning to pay off as impressive results are beginning to emerge across different clinical settings throughout Canada.
However, these provider-driven efforts are not enough. There is evidence suggesting that patients also play an important role in driving unnecessary care. In fact, in a recent survey of Canadians conducted by Ipsos Reid for Choosing Wisely Canada, 67% of respondents said that “patient demands are responsible for more unnecessary use of health services than are decisions by physicians”. Clearly, the perception that “more is better” needs to be addressed. 8

9. Better to get a test than “do nothing” Fear of litigation
I’ve always done this
Patients want it
New tests are good $$
Better to get a test than “do nothing”
Physician approach each visit to provide optimal care, but sometimes things get in the way.
Fear of litigation
Referring doctor wants it

10. Better Conversations 10

11. Better Conversations;
Tips for Providers
Provide clear recommendations, stating relevant clinical considerations.
Elicit patient beliefs/questions
Provide empathy and partnership
Confirm agreement on plan of action, overcome barriers.
Plan for follow-up 11

12. Choosing Wisely National Resources
Item
Usage
Poster – General messages
Display in all patient areas
Posters- Topic specific
Display in selected patient areas
Video – 30 second silent
Display on screens
Tent card
Four questions patients are encouraged to ask
Pamphlets - specific topics
Print as needed and hand out to support conversation
Physician recommendations
Reference for evidence
Physician CWA Quality Improvement Project Charter
In development, including baseline measures, intervention planned, and results 12

13. Choosing Dissemination
National materials PLUS
PLP Data Support
TOP CPGs
CME Supports
Requested: EMR Supports
Intervention Planning

14. This is a general imaging poster to promote the use of the 4 questions.

15. There are 2 patient pamphlets available, each put out by a different national society.

16. National Societies with Low Back Pain Recommendations
There are 5 national societies that have put out a recommendation related to imaging for Low Back Pain. Low Back Pain is the only topic to be identified as a priority by so many societies. 16

17. CWA Low Back Pain Partnerships
Project
Alberta Partnership
Spine Access Alberta
Bone & Joint SCN PRIHS I project to demonstrate, in two sites, a new multi-disciplinary team service delivery model to support low back pain care.
CWA Demo Project
Implementation of a new L-Spine Order Form
Working in collaboration with 3 Primary Care Networks to gather input and plan interventions based on their context.
Objectives:
Align to CWC key messages
Support physician engagement
Provide patient communication resources 17

18. CWA Demonstration Project; Physician and Patient Input
through 3 PCNs
Low Back Pain;
Physician interviews using Cognitive
Task Analysis (U. of Alberta)
Patient focus groups (PaCER – U. of Calgary)
Next steps: review themes, plan PCN level improvements. 
The purpose of a cognitive task analysis is to systematically define the decision requirements and
psychological processes used by expert individuals in accomplishing tasks/results.

19. Potential Interventions
Physician/Team
EMR support
KT events (CPG and data)
Healthy scripting
Team process improvement
Informed Patients
Pamphlets
Digital pamphlets
HUTV
PCN website resources
Care Options
Inter-disc. team services and roles
Self management group supports
Care Coordination
Specialist/specialty referral review
Improve referral process

20. Making the Best Decisions
Patients rely on their physicians to recommend the right tests and procedures based on their specific clinical needs. Doctors should use their knowledge, clinical judgement, and the best available evidence to guide their decisions, and they should speak with their patients about the appropriateness of specific tests and treatments. Physicians are called upon to use healthcare resources prudently, exercise appropriate judgment, and help their patients make informed decisions about their medical care. - Striking the Proper Balance, CMPA, Sept. 2014
This was taken from a recent article and we think it is an important point to make in support of Choosing Wisely in that the Canadian Medical Protective Association is encouraging physicians to be appropriate in the care they provide
We want to highlight the points that we have coloured in the middle (doctors should speak with their patients about the appropriateness of specific tests and treatments) which is about the important conversations that physicians and patients have together.

21. Alberta Provincial Partnerships
The Physician Learning Program (PLP), is a physician-driven program that provides practice-based feedback to specialist and family physicians 21

22. How can you get involved?
Display “More is Not Always Better”
Have healthy conversations
Give Low Back Pain pamphlets
Get Low Back Pain data
Talk to your peers to improve processes
Sign up for the Challenge
Display the More is Not Always Better posters and play the silent video in patient areas.
Follow the Provider Communication Tips to support healthy conversations with patients
Have the Low Back Pain pamphlets available to print for patients with Low Back Pain
Get data to review your practice of ordering imaging (EMR query, Physician Learning Program project)
Talk to your peers about ways to improve processes, and consider asking your PCN for support
Sign up for the Challenge to reduce 1M Unnecessary Tests and Treatments to support care for Albertans