Limited time with patients, lack of care continuity and discomfort with conversations about alternative medical treatments are just some of the barriers to the uptake of Choosing Wisely in clinical settings available to underserved communities, according to a recent report by the Connecticut Choosing Wisely Collaborative (CCWC).
The report captures insights and recommendations from a day-long Call to Action Summit, “Leveraging Choosing Wisely as a Tool for Achieving Health Equity,” held in October 2017 that brought together more than 120 national and local Choosing Wisely experts, adopters and stakeholders as well as community partners to discuss how the campaign can be used to empower and engage underserved populations in seeking the most effective health care.
“We wanted to explore how individuals in these groups reacted to the Choosing Wisely messaging about avoiding unnecessary and potentially harmful care when most had forgone or been unable to get the care they needed in the past,” said Nancy Yedlin, a member of the CCWC’s Leadership Council and Vice President of Donaghue Medical Research Foundation.
“For the campaign to be an effective empowerment tool for these individuals, we felt it was important to seek their views and examine the ways the campaign might better support historically underserved populations. We wanted to raise these issues up for a wider conversation beyond Connecticut as well,” Yedlin said, noting that passage of the federal Affordable Care Act and Connecticut’s expansion of Medicaid increased the state’s insured population by 300,000 and provided an opportunity for the Collaborative to dig deeper into questions of health equity.
The report outlines three main categories that should be addressed to ensure Choosing Wisely is useful in achieving greater health equity in the United States – better support for care teams, increased consumer education, and using culturally relevant messages and channels to reach racially and ethnically diverse communities.
The report defines health equity as the ability to obtain optimal health regardless of race, ethnicity or socioeconomic status, and requires programs, policies and practices that by their nature are not “one size fits all.”
“The campaign is being conducted within the context of a complex and changing health and health care landscape. These environmental and systems level realities present limits to the influence of the campaign while simultaneously offering opportunities for the campaign to address,” the report states.
The report also suggests several action opportunities based on its three main foci and on which stakeholders could take a leadership role – national partners, health systems, community-based organizations, and regulators, payers or accrediting agencies. Among the recommendations are:
- For engaging care teams, align messaging about low-value care across medical specialties and care settings
- For empowering consumers, engage community health workers to model questioning and information-seeking behavior for patients
- For targeted outreach, partner with trusted community leaders and neighborhood-based organizations to increase public awareness about overuse in health care
Yedlin said that summit participants, which included consumers, employers, health systems, payers and government representatives, have already created action steps that each constituency can take to implement the recommendations outlined in the summit report, including reaching new audiences.
“We are fortunate that for most Collaborative members, implementing Choosing Wisely in various ways ties directly to their organizational missions,” she said. “We want to share with and learn from others who are engaging with the campaign as an approach that can improve patient experience at point of care, help patients advocate for themselves to get safe and effective care, and reduce inequities.”
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