The importance of reducing unneeded medical testing and medications can be a complicated message for consumers to absorb, physicians say.
The ABIM Foundation has awarded a second round of grants for its Choosing Wisely campaign, which aims to educate clinicians and patients about reducing unneeded medical testing, procedures, and medication use.
The grants, which are funded by the Robert Wood Johnson Foundation, have been awarded to seven initiatives, all of which will work toward reducing the use of antibiotics for viral infections by at least 20% over nearly three years.
Lisa Letourneau, MD, MPH
The grantees each also chose at least two other Choosing Wisely recommendations to focus on, from the dozens of tests and procedures that Choosing Wisely recommends be scaled back, such as reducing imaging for low-back pain and reducing prescriptions for benzodiazepines for adults 60 and over.
The importance of reducing unneeded testing and medications can be a complicated message, especially for consumers, who have been conditioned to think that "more is better," says Lisa Letourneau, MD, MPH, executive director for Maine Quality Counts, one of the grantees.
"It's so counterintuitive to the culture in terms of accessing healthcare," she says.
The Maine Quality Country regional health improvement collaborative will work with other health organizations throughout Maine's Midcoast and Greater Bangor regions to spread the Choosing Wisely messages not only with patients, but also with clinicians.
Maine Quality Counts was a grantee during the first round, too, and heard a loud "we get it" from physicians, who said they felt like they were "swimming upstream" with patients who demand certain tests and medications when they're not feeling well.
"Stop beating us up," Letourneau said she heard physicians express. "Spend your time with the public."
This time around the focus will be not only on communicating the "choosing wisely" message to the public, but also figuring out the best way to do it. Letourneau says the key to spreading the word and making things click with the public is by conveying a complicated message in a succinct way.
She compares the "choosing wisely" message to other public health campaigns such as "don't drink and drive." But acknowledges that "choosing wisely" is more complex because it's not simply a question of convincing the public to stop a specific behavior.
"You don't want people to skimp on care they do need," she says. "What really resonates with people?"
The message for patients is: "Get the care you need and not the care you don't," she says. But in order for it to stick in people's minds and catch their imagination, "it's got to be a little sexier and catchier than that."
"I don't think anybody has really figured out the social marketing strategy," Letourneau says, but over the course of the 34-month grant period, her organization and its partners will work to find out.
"If you ask most school kids in Maine, they'll know what it means," she says. It's that kind of catchy messaging and recognition that Letourneau hopes they'll achieve around their Choosing Wisely work.
The Wisconsin Collaborative for Healthcare Quality is another second-round grantee that will work to spread the Choosing Wisely message more widely. Mary Riordan, the organization's director of member and community engagement, agrees that patient expectations can stand in the way of physicians implementing Choosing Wisely goals.
"A lot of patients have a cold, and they think they will rush in right away and get an antibiotic," she says, adding that the first round of their work helped physicians open up dialogue with patients about making the right healthcare choices. "Physicians are not just prescribing willy-nilly."
Still, when patients take time out of work and pay a co-pay to see a physician when they don't feel well, they expect help and answers, and also want to their money's worth. No one wants to be told that they might have to just have to cough for a month and that antibiotics won't work.
"Most of the barriers are related to consumer requests," echoes Judy Nowicki, MPA, BSN, RN, quality improvement specialist for the Wisconsin Collaborative for Healthcare Quality. "When you have low back pain you want something done."
And it's a predicament for physicians, who have limited time during each visit and want their patients to be satisfied.
"The physician gets squeezed sometimes when it comes to consumer requests," Nowicki says.
And yes, sometimes doctors cave-in to these requests. But perhaps this campaign will lead to fewer requests from patients and less caving-in by doctors.
"They certainly, understandably, respond to patients in a way that they don't think is the most evidence-based approach," sometimes, agrees Letourneau. "The risk of getting the test is something that we often don't talk about… It's really about having the conversation with the patient."
Alexandra Wilson Pecci is an editor for HealthLeaders.