Evaluating the Evidence for Choosing WiselyTM in Primary Care Using the Strength of Recommendation Taxonomy (SORT)

Abstract

Objective: The goal of this study was to evaluate the quality of evidence supporting primary care-relevant Choosing Wisely TM recommendations using the Strength of Recommendation Taxonomy (SORT).

Implementing Prudent Healthcare in the NHS in Wales; what are the barriers and enablers for clinicians?

“…In our research, clinicians noted that it was often difficult to reduce the level of interventions due to patient expectations, reflecting other literature which notes that that 53% of clinicians surveyed said they would order a hypothetical test if a patient insisted, even if they knew it to be unnecessary . However, the authors note that this could be mitigated by evidence‐based recommendations around unnecessary care that could be discussed with patients and that evidence to underpin decision making in terms of reducing treatment was important . It is also suggested that campaigns such as Choosing Wisely have had some success in reducing unnecessary tests…”

An echo to Choosing Wisely^® in Switzerland

“…In the US, the strength of the Choosing Wisely recommendations has been controversial. Lin and Yancey 19 applied the Strength of Recommendation Taxonomy (SORT) system to 229 Choosing Wisely recommendations likely to be relevant in primary care. 26 Of these recommendations, 43 (19%) were rated as SORT level of evidence A, a consistent and good-quality patient-oriented evidence.…”

“…As a result, the authors concluded that the majority of the recommendations were based on expert consensus and disease-oriented evidence. 19 As described before, Swiss recommendations are also based on an expert consensus.…”

“…The effect of such recommendations has been controversial since it is based on expert consensus rather than patient-oriented evidence. 19 A recent analysis of claims data (billing codes) identified a reduction of only two of the seven “low-value service” measures after Choosing Wisely was released in the US. 20 …”

Research in Family Medicine by Family Physicians for the Practice of Family Medicine

“…One reason the campaign is even needed is illustrated by Lin and Yancey, 13 who found that most of the Choosing Wisely recommendations are based on expert opinion, Strength of Recommendation Taxonomy 14 category C evidence, rather than category A or B, which would reflect more research-based evidence. Family medicine researchers: give us better evidence to help us choose more wisely.…”