Choosing Wisely? Let’s Start with Working Wisely

Abstract

There is an increasing emphasis on quality and, relatedly, cost-effectiveness as it relates to the delivery of health care. Choosing Wisely is an initiative adopted by numerous specialties with the goal of starting a dialogue about efficient use of health care resources. People need to be able to access care to have an opportunity to choose wisely. There is a considerable amount of evidence that access to care is poor for specialty mental health care, particularly access to psychiatrists. Consequently, we suggest that psychiatrists and the broader mental health system need to consider working wisely, and in our paper outline key issues (for example, implementation of wait times and objective measures of need in a centralized referral management system; incorporation of performance indicators with longitudinal monitoring for continuous quality improvement) that need to be addressed to develop a mental health system that would allow people to access care to choose wisely. Abré géOn met de plus en plus l'accent sur la qualité et, corollairement, sur la rentabilité de la prestation des soins de santé. « Choisir avec soin » est une initiative adoptée par un certain nombre de spécialités dans le but d'amorcer un dialogue sur l'utilisation efficace des ressources de soins de santé. Les personnes doivent être capables d'accéder aux soins pour avoir la possibilité de « choisir avec soin ». Des données probantes en quantité considérable indiquent que l'accès aux soins est mauvais pour les soins de santé mentale de spécialité, particulièrement l'accès aux psychiatres. Par conséquent, nous suggérons que les psychiatres et le système de santé mentale en général devraient envisager de « Travailler avec soin », et nous présentons dans cet article les principaux enjeux (p. ex., la mise en oeuvre des temps d'attente et des mesures objectives des besoins dans un système de gestion d'aiguillage centralisé; l'incorporation des indicateurs de rendement avec la surveillance longitudinale de l'amélioration continue de la qualité) qui doivent être abordés afin de mettre au point un système de santé mentale qui permettrait aux gens d'accéder aux soins afin de « choisir avec soin ».Keywords access to care, health service delivery, evidence-based medicine, Choosing WiselyThere is an increasing emphasis on quality and, relatedly, cost-effectiveness as it relates to the delivery of health care.

Prioritization of non-recommended clinical activities in Primary Care

“…La iniciativa Choosing Wisely está ahora en por lo menos dieciocho países 26 . El reto actual es des-adoptar de forma efectiva todas las prácticas identificadas por las sociedades científicas.…”

The Psychiatrist as Clinical Behavioural Scientist

“…Poor public access to evidence-based care is the biggest current challenge for psychiatrists in Canada. [1][2][3][4] Despite a huge increase in prescriptions for antidepressants, there is no evidence that the impact of depression is decreasing, 5 suggesting an urgent need for better access to psychological treatments. 2 Psychiatrists tend to practice in ways that limit access and create a misalignment so that many people who need services do not receive them and some people who do not require specialty services have access.…”

“…3,4 Resources for mental health are finite, and reform is needed to improve access to effective treatment, particularly evidence-supported behavioural interventions. 1,4 Although efficacious behavioural treatments do exist for anxiety, depression, and related disorders, patients seeking treatments rarely receive them because of lack of expertise and coordination in community mental health settings. 6 Psychiatrists can become agents of change by assuming a leadership role as clinical behavioural scientists in the development, evaluation, implementation, and dissemination of behavioural treatments in the community.…”