Dialogue needed regarding non-value-added services and products: American Academy of Orthopaedic Surgeons

The purpose of the Choosing Wisely campaign is to encourage and facilitate more informed dialogue between patients and their physicians regarding the use of non-value-added healthcare services and products, says Kevin Bozic, MD, MBA, who is chair of the American Academy of Orthopaedic Surgeons Council on Research and Quality. “When there is evidence that a test, procedure or product may be overutilized with little benefit to the patient, then it should be put on a ‘Choosing Wisely’ list,” he says.

For example, consumers/patients spend $758 million on glucosamine/chondroitin supplements each year, but the evidence does not show that it is a beneficial treatment, adds Bozic. Getting the word out about non-value-added health services through the Choosing Wisely campaign and other publications helps to further spread awareness.

AAOS has made every effort to heighten its members’ awareness of Choosing Wisely, using its member magazine, social media, annual meeting, articles with Consumer Reports, and digitally through the iTriage app, he says. AAOS lacks a mechanism to measure its members compliance with the recommendations, but the Academy is exploring partnerships with other stakeholders to provide measurement tools for its members “to improve the quality of care they provide to their patients, including adherence to evidence-based care recommendations.”

Change isn’t always easy, though, he says. “Many factors influence the decisions of patients and their healthcare providers regarding utilization of low-value services. Many patients and their physicians believe that despite limited evidence to support the use of certain healthcare services and products, their individual circumstances may be different, and therefore they may be more likely to benefit. As our payment and delivery systems evolve to give both patients and providers more ‘skin in the game’ through greater accountability for costs and outcomes, we believe that programs like Choosing Wisely and evidence-based clinical practice guidelines will be more likely to be adopted.”

AAOS: Five Things Physicians and Patients Should Question

From Choosing Wisely, an initiative of the ABIM Foundation,

  1. Avoid performing routine post-operative deep vein thrombosis ultrasonography screening in patients who undergo elective hip or knee arthroplasty.
  2. Don’t use needle lavage to treat patients with symptomatic
    osteoarthritis of the knee for long-term relief.
  3. Don’t use glucosamine and chondroitin to treat patients with symptomatic osteoarthritis of the knee.
  4. Don’t use lateral wedge insoles to treat patients with symptomatic medial compartment osteoarthritis of the knee.
  5. Don’t use post-operative splinting of the wrist after carpal tunnel release for long-term relief.