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Choosing Wisely Canada (CWC) is a Canadian based health education campaign launched on April 2, 2014 under the leadership of Dr. Wendy Levinson, in partnership with the Canadian Medical Association, and based at the University of Toronto.〔Levinson W, Huynh T. Engaging physicians and patients in conversations about unnecessary tests and procedures: Choosing Wisely Canada. CMAJ. 2014 Mar 18;186(5):325-6.〕 The campaign aims to help physicians and patients engage in conversations about unnecessary tests, treatments and procedures, and to assist physicians and patients in making informed and effective choices to ensure high quality care.〔Canadian Medical Association (). Choosing Wisely Canada.Ottawa, ON: Canadian Medical Association; 2014. Available from:www.cma.ca/En/Pages/choosing-wisely-canada.aspx.〕 The campaign is based on the notion that unnecessary tests, treatments, and procedures often do more harm than good, resulting in poor clinical outcomes and significant waste in the Canadian healthcare system.〔Horwitz LI, Masica AL, Auerbach AD. Introducing Choosing Wisely®: Next steps in improving healthcare value. J Hosp Med. 2015 Mar;10(3):187-9〕 These unnecessary tests and procedures take away from care by potentially exposing patients to harm, leading to more testing to investigate false positive tests, and contributing to unnecessary anxiety and avoidable costs for patients. ''Choosing Wisely Canada'' aims to encourage and empower physicians to assimilate, evaluate, and implement the ever-increasing amount of evidence on current best practice. The campaign also supports the equally important role of patient education and the need to dispel the false notion that “more care is better care”. 〔 Central to the campaign are lists of "Five Things Physicians and Patients Should Question" developed by more than forty-five Canadian specialty societies. These lists are intended to encourage physicians to adopt a "think twice" attitude to avoid unnecessary and potentially harmful tests and procedures, and to foster discussions between patients and physicians about inappropriate care. The campaign also uses patient-friendly education materials to complement these lists, as well as teaches medical trainees about resource stewardship. As of June 2, 2015, 151 physician recommendations and 26 lay language patient educational materials have been released . ''Choosing Wisely Canada'' leads an international community, made up of nations who are implementing similar programs in their respective countries. At present, this community includes representation from Australia, Austria, Brazil, Denmark, England, France, Germany, India, Israel, Italy, Japan, Netherlands, New Zealand, South Korea, Switzerland, United States and Wales. ==Motivation== Choosing Wisely Canada stems from worldwide concern around providing unnecessary treatment when the risk of harm exceeds its potential benefit ("medical overuse").〔Morgan DJ, Wright SM, Dhruva S. Update on medical overuse. JAMA Intern Med. 2015 Jan;175(1):120-4〕 A number of studies have highlighted the prevalence of medical overuse in Canada, which include findings that approximately 50% of prescriptions for respiratory infections in Saskatchewan are inappropriate,〔Wang, E. E., Einarson, T. R., Kellner, J. D., & Conly, J. M. (1999). Antibiotic prescribing for Canadian preschool children: evidence of overprescribing for viral respiratory infections. Clinical infectious diseases, 29(1), 155-160.〕 28% of lumbar spine MRIs in Alberta and Ontario are unnecessary,〔Emery, D. J., Shojania, K. G., Forster, A. J., Mojaverian, N., & Feasby, T. E. (2013). Overuse of magnetic resonance imaging. JAMA internal medicine,173(9), 823-825.〕 and 28% of bone mineral density scans are inappropriate.〔Papaioannou A, Morin S, Cheung AM, Atkinson S, Brown JP, Feldman S, et al. 2010 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada: Summary. CMAJ. 2010 Nov 23;182(17):1864-73.〕 These unnecessary invasive procedures and low value care are major causes of preventable harm and increased waste of medical resources.〔Berwick, D. M., & Hackbarth, A. D. (2012). Eliminating waste in US health care. Jama, 307(14), 1513-1516.〕 Medical overuse has been associated with decreased patient satisfaction and poor clinical outcomes, including higher mortality.〔Fisher, E. S., Wennberg, D. E., Stukel, T. A., Gottlieb, D. J., Lucas, F. L., & Pinder, E. L. (2003). The implications of regional variations in Medicare spending. Part 1: the content, quality, and accessibility of care. Annals of internal medicine, 138(4), 273-287.〕 A systematic survey of patients in seven countries revealed that 10-20% of patients believed that their physicians had provided treatment of little or no value in the past two years.〔Schoen, C., Osborn, R., Doty, M. M., Bishop, M., Peugh, J., & Murukutla, N. (2007). Toward higher-performance health systems: adults’ health care experiences in seven countries, 2007. Health Affairs, 26(6), w717-w734.〕 Further studies highlighted the financial strain of medical overuse, such as the analysis conducted by the Institute of Medicine, which found that up to 30% of American health care spending is on unnecessary tests and procedures.〔Schwartz AL, Landon BE, Elshaug AG, Chernew ME, McWilliams JM. Measuring Low-Value Care in Medicare. JAMA Intern Med. 2014. Epub ahead of print.〕 In light of these concerns, Choosing Wisely Canada hopes to optimize value, reduce waste and improve patient outcomes by promoting patient-physician conversations about low-value care. 抄文引用元・出典: フリー百科事典『 ウィキペディア（Wikipedia）』 ■ウィキペディアで「Choosing Wisely Canada」の詳細全文を読む スポンサード リンク
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