Two years ago, Dr. Richard Morel learned about Choosing Wisely® at an American Medical Group Association (AMGA) conference during a presentation by Consumer Reports’ Medical Director, Dr. John Santa. Dr. Morel, Vice President and Associate Medical Director at WESTMED, a medical group of approximately 300 physicians in New York’s Westchester County, was already interested in high-value care and quickly became intrigued in how he could institute a Choosing Wisely project within his medical group.
Physicians at WESTMED began their Choosing Wisely project by challenging the various specialty groups within the organization to focus on one recommendation from their specialty society’s list. For example, the medical group’s neurologists chose reduction in imaging for diagnosing headaches; the orthopedists chose reduction in imaging for preliminary low-back pain with no red flags; and internal medicine chose reduction in antibiotic use for sinusitis.
To expand their reach and ensure consistent messaging, the internal medicine team worked in conjunction with the pediatric and family medicine departments to limit prescribing antibiotics for sinusitis. Each physician on these teams pledged not to write prescriptions for antibiotics for patients presenting with sinus infections unless they met one of the following three specific criteria, per recommendations from the American Academy of Family Physicians, the American Academy of Pediatrics and the American Academy of Allergy, Asthma and Immunology:
- Duration of symptoms must be greater than or equal to seven days and include two of the following: maxillary tooth pain, drainage with pus, nasal congestion, facial pain, and/or significantly reduced sense of smell;
- initial improvement followed by worsening in more than or equal to four days; and,
- fever for three consecutive days and discharge with pus.
The health care providers working on the antibiotics-reduction project educate patients in advance of entering the exam room by showcasing the Consumer Reports 5 Questions to Ask Your Doctor Before You Take Antibiotics poster in over 40 of their internal medicine, pediatric and urgent care waiting rooms. In addition, they placed Consumer Reports glossy handouts in their waiting rooms and some exam rooms, including the handout titled “Treating sinus problems: Don’t rush to antibiotics.”
WESTMED also posted information about the campaign on their website and shared through their social media outlets.
Dr. Morel says that the patient outreach and other publicity around antibiotic overuse have led to a perceived decrease in requests for antibiotics. “I believe that some patients come in wanting antibiotics but then they change their mind when they see a poster that asks, ‘Do I really need antibiotics?’ Patients are now getting more educated before they even come into the exam room, and that saves a lot of time and leads to a much better conversation during the appointment.”
WESTMED has also incorporated Consumer Reports brochures into their electronic medical records so that during or after appointments providers can immediately share this information to their patients.
While there were some initial concerns at WESTMED that these kinds of conversations with patients may take up too much time during an office visit, those fears have not played out in practice.
“Our doctors are busy, just like they are everywhere,” Dr. Morel conceded. “This was just one more target to hit in an already overwhelmingly complex day. But if you promote the campaign and materials as tools to educate your patients before they even get into the exam room, doctors are already two steps ahead of where they would have been at the start of an appointment. This saves time and makes our job easier. And if you make the right thing to do the easy thing to do, you’ll always have success.”