The Impact of the Choosing Wisely Campaign in Urology

Urology. 2018 Jun:116:81-86. doi: 10.1016/j.urology.2018.03.005. Epub 2018 Mar 20.

Abstract

Objective: To determine if 3 of the Canadian Urological Association's Choosing Wisely recommendations (released in 2013-2014) related to urologic care altered physician and patient behavior.

Methods: Administrative data from Ontario, Canada between 2008 and 2017 was used. We identified 3 cohorts: First, we determined how many men >66 years of age had a serum testosterone level before starting testosterone therapy. Second, we determined how many boys undergoing an orchiopexy underwent abdominal imaging before their surgery. Third, we determined how many men with low risk prostate cancer underwent a Bone Scan after diagnosis. Piece-wise linear regression was used to evaluate for a significant change after Choosing Wisely.

Results: We identified 13,113 men who had their initial prescription for testosterone filled. Serum testosterone measurement increased over time, from approximately 43% to 68%. There were 9319 boys who underwent an orchiopexy. The use of pre-orchiopexy ultrasound was generally stable (approximately 55%). We identified 27,174 men with low risk prostate cancer. The use of bone scans after diagnosis decreased over time from approximately 24% to 20%. In all 3 of these groups, there was no significant change after Choosing Wisely (P = .74, P = .70, P = .72 respectively).

Conclusion: In Ontario, there was no evidence of a significant change in 3 practice patterns that were featured in Choosing Wisely Urology recommendations. Further thought may be needed on how to translate these and future recommendations into behavior change.

MeSH terms

  • Adenocarcinoma / diagnostic imaging
  • Adenocarcinoma / secondary
  • Bone Neoplasms / diagnostic imaging
  • Bone Neoplasms / secondary
  • Cost Savings
  • Cryptorchidism / diagnostic imaging
  • Cryptorchidism / surgery
  • Diagnostic Imaging / economics
  • Diagnostic Imaging / statistics & numerical data
  • Guideline Adherence / economics
  • Guideline Adherence / statistics & numerical data*
  • Health Promotion*
  • Humans
  • Male
  • National Health Programs / economics
  • Ontario
  • Orchiopexy
  • Positron-Emission Tomography / economics
  • Positron-Emission Tomography / statistics & numerical data
  • Practice Guidelines as Topic*
  • Practice Patterns, Physicians' / economics
  • Practice Patterns, Physicians' / statistics & numerical data*
  • Procedures and Techniques Utilization
  • Prostatic Neoplasms / pathology
  • Testosterone / blood
  • Testosterone / therapeutic use
  • Unnecessary Procedures / economics
  • Urology* / economics
  • Urology* / statistics & numerical data

Substances

  • Testosterone