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: 
MSP Practitioner File
Consolidation - demographic (Ministry of Health)
Births (BC Vital Statistics Agency)
Hospital Separations (BC Ministry of Health)
Deaths (BC Vital Statistics Agency)
PharmaNet
Consolidation registry (Ministry of Health)
Medical Services Plan (BC Ministry of Health)
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: May 13, 2019