RESEARCH – February 2019

Choosing wisely: assessments by Estonian internists

Authors: Margus Lember

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Background. The Choosing Wisely campaign initiated in 2012 in the USA invites professional medical organisations to find out medical procedures and investigations that are useless for patients and, through omitting them, to improve the quality of health care and to lower health care costs. The European Federation of Internal Medicine has invited its member organisations to perform similar studies in Europe.

Aim. To present the campaign Choosing Wisely and find out 10 most important recommendations from the viewpoint of internal medicine for improving the quality of care and to ensure optimal use of health care resources through limiting or omitting certain procedures, or through their critical appraisal.

Methods. The methodology of the study followed that used in many other countries: all 698 recommendations of the Choosing Wisely USA and Canada were assessed. Assessment was to simultaneously include the frequency and importance of the problem as well as the probable effect from the viewpoint of internists. As the first step, 10 experts of internal medicine selected 30 most important items out of 698. As the second step, these 30 items were assessed by all members of the Estonian Society of Internal Medicine. Ten most important recommendations were listed.

Results. The most important results were recommendations to assess the whole treatment scheme while adding a new medication; to assess how a planned investigation or treatment may influence the management plan and clinical course of disease; minimal use of invasive devices and catheters because of the risk of infections; preference of peroral medications when possible; weighting risks and benefits as well as the personal preferences of elderly fragile patients in planning hospitalisation, investigations and treatment.