Co přinášejí pro klinickou praxi mezinárodní aktivity Less is more a Choosing wisely?

Zusammenfassung. Die Top-9-Liste der Schweizerischen Gesellschaft für Intensivmedizin (SGI) wurde 2017 veröffentlicht. Welchen Stand hat diese Initiative in Bezug auf ihre Umsetzung auf den Schweizer Intensivstationen? Welches sind ihre Auswirkungen auf die Patientenversorgung und auf die Kosten der Intensivmedizin? Welche evidenzbasierten, neueren Entwicklungen rechtfertigen eine Aktualisierung der Liste und welche Massnahmen sind erforderlich, um diese Initiative erfolgreich in den kommenden Jahren fortzusetzen? Der folgende Artikel gibt einen aktuellen Überblick über die «Choosing Wisely®»-Initiative der SGI.

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598. Choosing Wisely with CD4 Counts: When Less Is More

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy210.605 ◽

2018 ◽

Vol 5 (suppl_1) ◽

pp. S219-S219

Author(s):

Don Bambino Geno Tai ◽

Arlene Yu ◽

Robert Goldstein

Keyword(s):

Choosing Wisely ◽

Cd4 Counts ◽

Less Is More

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Using a Triple Aim Approach to Implement “Less-is-More Together” and Smarter Medicine Strategies in an Interprofessional Outpatient Setting: Protocol for an Observational Study (Preprint)

10.2196/preprints.13896 ◽

2019 ◽

Author(s):

Monique Lehky Hagen ◽

René Julen ◽

Pierre-Alain Buchs ◽

Anne-Laure Kaufmann ◽

Jean-Michel Gaspoz ◽

...

Keyword(s):

Health Care ◽

Observational Study ◽

Interprofessional Collaboration ◽

Choosing Wisely ◽

Medical Society ◽

Triple Aim ◽

Less Is More ◽

Care Assessment ◽

Final Questionnaire

BACKGROUND Increased awareness of the world’s problematic growing health care expenditure and health care shortages requires sustainable use of available resources. To promote cultural changes in medical mindsets, societies representing medical specialties have developed new Choosing Wisely strategies. The Valais Medical Society and the Valais Pharmacy Association have developed an interprofessional collaboration project entitled “Less-is-more Together-PPI” to analyze and optimize change management practices focusing on the prescription and deprescription of proton pump inhibitors (PPIs). OBJECTIVE This study aims to enhance interprofessional collaboration between physicians, pharmacists, and patients to optimize PPI use, avoid unnecessary treatments and improve therapeutic adherence to indicated therapies, and to analyze hindrances and facilitators to implementing interprofessional Less-is-more strategies in the field. METHODS Home-dwelling adults domiciled in Valais and prescribed PPIs in the last 6 months will be invited to participate in this observational study. The studied subpopulation will be constituted of consenting patients whose physicians and pharmacists also voluntarily agree to participate. The process of collecting, pooling, transmitting, evaluating, and protecting data has been validated by the Human Research Ethics Committee of the Canton Vaud. RESULTS The Primary Triple Aim outcome measures will be (1) population health: patient’s assessment of their own health, functional status, and disease burden using a monthly questionnaire for 6 months; Behavioral/physiological factors will be investigated using a final questionnaire at 6 months, (2) experience of care: assessment using a final questionnaire for participating patients, pharmacists and physicians, and an analysis of negative/positive experiences via 6 follow-up questionnaires, and (3) Per capita cost: participants’ fluctuating or decreasing PPI intake (number of pills/dosage) and an analysis of participants’ different categories following their medical prescription, in relation to possible bias effects on the overall drug intake of the population studied. Secondary outcomes will be participation rates; patient, physician, and pharmacist follow-up; and evaluations of participants' experiences and their perceived benefits, as well as whether the interprofessional process can be improved. CONCLUSIONS This project seeks a deeper understanding of how Less-is-more and smarter-medicine strategies are perceived by patients and health care providers in their daily lives in a very specific context. It will reveal some of the hindrances to and facilitators for efficient cultural change toward a more sustainable health care system. The results will be useful to optimize and scale up further Choosing Wisely approaches. INTERNATIONAL REGISTERED REPOR DERR1-10.2196/13896

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Choosing wisely in cardiology: Five proposals from the Italian Association for Cardiovascular Prevention and Rehabilitation

Monaldi Archives for Chest Disease ◽

10.4081/monaldi.2019.1049 ◽

2019 ◽

Vol 89 (2) ◽

Author(s):

Marika Werren ◽

Roberto Copetti ◽

Nicola Gaibazzi ◽

Franco Giada ◽

Andrea Faggiano ◽

...

Keyword(s):

Calcium Score ◽

Cardiovascular Prevention ◽

Choosing Wisely ◽

Native Valve ◽

Italian Association ◽

Less Is More ◽

Electrocardiographic Monitoring ◽

Slow Medicine ◽

Bleeding Prophylaxis ◽

Chest X Ray

We do not always accomplish what is best for our patients. Is “more procedures, more drugs” a real synonym of good and always useful medicine? Probably not. Indeed, it has been highlighted that many tests and treatments, widely used in medical practice, do not bring benefits to patients, but can be harmful. So, why do we keep performing them? Many reasons, surely one of the main is the constant fear of malpractice legal-medical consequences; this led to the development of a defensive medicine, no longer focused on the health of the patient. For this reason, the Italian Association of Cardiac Prevention and Rehabilitation (GICR-IACPR) joined an international project “Choosing Wisely”, supported by the Slow Medicine Initiative, a network which states that “Less is more”. The purpose of the “Choosing Wisely” project is to improve the quality and safety of health services through the reduction of practices that, according to available scientific knowledge, do not bring significant benefits to the patients, but can, on the opposite, expose them to risks. This GICR-IACPR paper proposes to avoid five widespread practices in cardiology, at risk for inappropriateness and lacking of clinical evidence of benefit: i) do not perform routine chest X-ray in patients entering rehabilitation programme after cardiac surgery; ii) do not perform Computed Tomography for coronary calcium score in patients at high cardiovascular risk; iii) do not perform Holter electrocardiographic monitoring in patients suffering from syncope, near syncope or dizziness, in whom a non-arrhythmic origin has been documented; iv) do not routinely prescribe proton pump inhibitors (PPI) for gastrointestinal bleeding prophylaxis in patient with single drug antiplatelet therapy in absence of additional risk factors; v) avoid routine use of infective endocarditis prophylaxis in mild to moderate native valve disease.

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Sobrediagnóstico e tratamento excessivo: Médicos generalistas - é hora de uma revolução na medicina

Revista Brasileira de Medicina de Família e Comunidade ◽

10.5712/rbmfc11(38)1400 ◽

2016 ◽

Vol 11 (38) ◽

pp. 1-5 ◽

Cited By ~ 1

Author(s):

Julian Treadwell ◽

Margaret McCartney

Keyword(s):

Choosing Wisely ◽

Less Is More ◽

Slow Medicine

Práticas médicas ineficientes e prejudiciais sempre estiveram conosco, mas a escala e institucionalização do sobrediagnóstico e do tratamento excessivo se expandiram exponencialmente nas últimas décadas.Este tema tem sido articulado em movimentos mundiais, tais como as conferências para Prevenção de Sobrediagnóstico, e campanhas como “Medicina em Demasia” (“Too Much Medicine”), do BMJ, “Menos é Mais” (“Less is More”) da JAMA, o movimento italiano “Desacelerem a Medicina” (“Slow Medicine”) e o projeto “Escolhendo com Inteligência” (“Choosing Wisely”), dos EUA (e agora internacional). (...)

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