Evaluating the Impact of Choosing Wisely Canada Drug Recommendations

Project number: 
17-151
Approval date: 
Monday, December 4, 2017
Principal Investigator: 
Law,Mike
Institution: 
Centre for Health Services and Policy Research (CHSPR)
Funding Agency: 
Not Available
Datasets requested: 
Not available
Research objective: 

We will assess the drug-related choosing wisely recommendations to determine if the recommendations have had an impact. These include:

-Don't recommend routine or multiple daily self-glucose monitoring in adults with stable type 2 diabetes on agents that do not cause hypoglycemia
-Don't prescribe testosterone therapy unless there is biochemical evidence of testosterone deficiency
-Don't use antibiotics for upper respiratory infections that are likely viral in origin, such as influenza-like illness, or self-limiting, such as sinus infections of less than seven days of duration
-Don't advise non-insulin requiring diabetics to routinely self-monitor blood sugars between office visits.
-Don't maintain long term Proton Pump Inhibitor (PPI) therapy for gastrointestinal symptoms without an attempt to stop/reduce PPI at least once per year in most patients
-Don't routinely use long term steroid therapy in inflammatory bowel disease
-Don't use antimicrobials to treat bacteriuria in older adults unless specific urinary tract symptoms are present
-Don't use benzodiazepines or other sedative-hypnotics in older adults as first choice for insomnia, agitation or delirium
-Don't use antipsychotics as first choice to treat behavioural and psychological symptoms of dementia
-Don't prescribe nonsteroidal anti-inflammatory drugs (NSAIDS) in individuals with hypertension or heart failure or CKD of all causes, including diabetes
-Don't prescribe angiotensin converting enzyme (ACE) inhibitors in combination with angiotensin II receptor blockers (ARBs) for the treatment of hypertension, diabetic nephropathy and heart failure
-Do not use SSRIs as the first-line intervention for mild to moderately depressed teens
-Do not use atypical antipsychotics as a first-line intervention for Attention Deficit Hyperactivity Disorder (ADHD) with disruptive behaviour disorders
-Do not use psychostimulants as a first-line intervention in preschool children with ADHD
-Do not routinely use antipsychotics to treat primary insomnia in any age group
-Do not routinely use antidepressants as first-line treatment for mild or subsyndromal depressive symptoms in adults
-Do not routinely continue benzodiazepines initiated during an acute care hospital admission without a careful review and plan of tapering and discontinuing, ideally prior to hospital discharge
-Do not routinely prescribe high-dose or combination antipsychotic treatment strategies in the treatment of schizophrenia
-Do not use antipsychotics as first choice to treat behavioural and psychological symptoms of dementia
-Do not use benzodiazepines or other sedative-hypnotics in older adults as first choice for insomnia
-Don't prescribe bisphosphonates for patients at low risk of fracture
-Don't prescribe testosterone to men with erectile dysfunction who have normal testosterone levels

Hypothesis: Overall, the choosing wisely recommendations led to a modest reduction in inappropriate prescribing.


Page last revised: January 2, 2018