Choosing Wisely Campaign Only Modestly Reduces Unnecessary Services

Of 7 treatment and testing services listed by the Choosing Wisely campaign as usually unnecessary, the use of only 2 have decreased, while use of the other 5 either have not changed or have increased since the campaign began, according to a study in the December 2015 issue of JAMA Internal Medicine.

The Choosing Wisely campaign was created by the American Board of Internal Medicine Foundation in 2012 to help raise awareness and provide a new approach to clinical decision-making, and to help reduce the use of wasteful and unnecessary medical procedures and treatments. Alan Rosenberg, MD, vice president of clinical pharmacy and medical policy at Anthem Inc, and his colleagues analyzed insurance claims data for Anthem-affiliated commercial health plans to see how services deemed low-value by the Choosing Wisely campaign were being used.

From the 70 lists of services or procedures considered by various medical societies to be of minimal clinical benefit in most situations, the investigators chose 7 services:

• Imaging tests for uncomplicated headache
• Cardiac imaging without a history of cardiac conditions
• Low-back pain imaging without red-flag conditions
• Preoperative chest X-rays with unremarkable history and physical examination results
• Human papillomavirus (HPV) testing for women younger than 30 years of age
• Antibiotics for acute sinusitis
• Prescription nonsteroidal anti-inflammatory drugs (NSAIDs) for patients with hypertension, heart failure, or chronic kidney disease.

In an analysis of at least 10 quarters of claims data for each service on the list, a statistically significant decline was seen in only 2 of the services: imaging for headaches with uncomplicated conditions (decreased from 14.9% to 13.4%; a 10.1% relative reduction) and cardiac imaging in the absence of cardiac disease (decreased from 10.8% to 9.7%; a 10.2% relative reduction). Use of 3 services remained the same (preoperative chest x-rays, lower-back pain imaging, and use of antibiotics for acute sinusitis). However, 2 services actually increased in use: HPV testing in women younger than 30 (25% increase), and use of prescription NSAIDs by patients with 1 or more of the previously identified chronic conditions (12.5% relative increase). The 10 quarters analyzed went up through the third quarter of 2013.

The investigators conclude that additional interventions are needed for wider implementation of Choosing Wisely recommendations, and the authors recommend new measures to effect meaningful change in practitioner knowledge and behavior.