Abstract
Abstract: Objective: to evaluate the implementation of the Choosing Wisely (CW) campaign strategies at a medical clinic internship. Methods: This interventional study involved internship teachers and students, using online questionnaires on the SurveyMonkey platform, and face-to-face activities. Using the Delphi technique, teachers identified three unnecessary situations that commonly occur in practice. The recommendations were grouped by frequency and subject, adapted to the CW format. A Likert scale was used to classify the specialists’ opinion aiming to obtain the final list of recommendations. Before the introduction of the CW campaign, we conducted an Objective Structured Clinical Examination (OSCE). Two groups of students were compared: one group that underwent the same OSCE evaluation before the implementation of the CW campaign (110), and another group that participated of all educational actions (n = 98). The CW campaign was implemented by developing educational actions using the recommendations during workshops, banners, and theoretical evaluation, in addition to an Objective Structured Clinical Examination (OSCE). Results: after grouping the recommendations, 24 items remained. The specialists selected eight recommendations by frequency, addressing unnecessary behaviors such as requesting multiple exams, overuse of non-hormonal anti-inflammatory drugs, the indication of digestive endoscopy in younger patients with dyspepsia, excessive chest X-rays in intensive care unit, prescribing antibiotic prophylaxis for longer than recommended, routine indication of allergic tests, inadequate initial screening for thyroid assessment, and spirometry in asymptomatic patients. The educational actions resulted in a process of awareness and discussion among the participants, evidenced by theoretical evaluation (> 95%), as well as in the OSCE, where the level of successes was higher in the exposed group when compared to the nonexposed group (p = 0.001). Conclusion: the implementation of the CW campaign improved the clinical skills of medical clinic internship students and allowed positive discussions about cost-consciousness in health.
Highlights
The “Choosing Wisely” campaign has drawn attention worldwide as a potentially promising approach to the problem of unnecessary care
Seventy-three percent of the 600 physicians recognized that over-testing and excessive procedures are serious problems for the health care system; 72% reported requesting an unnecessary test or procedure at least once a week; 47% reported that patients request an unnecessary exam, and 53% of the physicians admitted they would request an unnecessary test if the patients insisted in their request
We aimed to evaluate the effect of the Choosing Wisely (CW) campaign implementation on the medical internship of a medical clinic
Summary
The “Choosing Wisely” campaign has drawn attention worldwide as a potentially promising approach to the problem of unnecessary care. The campaign focuses its actions on the value of care and potential risks to patients, rather than using cost as a motivating factor in healthcare[1]. In 2014, the American Board of Internal Medicine (ABIM) interviewed 600 physicians about the use of unnecessary tests and procedures in the health care system. Seventy-three percent of the 600 physicians recognized that over-testing and excessive procedures are serious problems for the health care system; 72% reported requesting an unnecessary test or procedure at least once a week; 47% reported that patients request an unnecessary exam, and 53% of the physicians admitted they would request an unnecessary test if the patients insisted in their request. The costly results of defensive medicine were the over-requesting of tests or procedures to reduce concerns about malpractice liability risk 7
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