Choosing wisely helps patients get the right care

29 April 2015

The Royal Australian College of General Practitioners (RACGP) has released its top five tests, treatments and procedures that should be questioned by GPs and their patients, as part of the launch of Choosing Wisely Australia.

Created by GPs, the top five list includes recommendations around the prescribing of medications for stomach acid and reflux; the appropriate screening of low-risk patients for vascular disease; and the use of blood glucose monitoring for people with type 2 diabetes.

RACGP President Dr Frank R Jones said the list had been created as part of Choosing Wisely Australia to encourage GPs and their patients to think about and discuss medical tests, treatments and procedures where evidence shows they provide no overall benefit and, in some cases, may lead to harm.

“With its recommendations based on best evidence, Choosing Wisely Australia will play an essential role in helping GPs engage in conversations with their patients about the right care,” Dr Jones said.

“The aim is to create an awareness among patients that perhaps not all tests and treatments are needed. GPs can start these conversations by giving patients the facts and outlining why a test or treatment may not be the right option.

“Providing patients with information is the key to helping them understand that more tests and treatments is not always better. When patients understand the issues, they're more likely to have the confidence to speak up and let their GP know they aren't necessarily expecting or wanting a particular intervention unless it's really needed,” Dr Jones said.

The RACGP’s top five tests, treatments or procedures that should be questioned by GPs and their patients are:

1. Don't use proton pump inhibitors (PPIs) long term in patients with uncomplicated disease without regular attempts at reducing dose or ceasing.
2. Don’t commence therapy for hypertension or hyperlipidaemia without first assessing the absolute risk of a cardiovascular event.
3. Don’t advocate routine self-monitoring of blood glucose for people with type 2 diabetes who are on oral medication only.
4. Don't screen asymptomatic, low-risk patients (<10% absolute 5-year CV risk) using ECG, stress test, coronary artery calcium score, or carotid artery ultrasound.
5. Avoid prescribing benzodiazepines to patients with a history of substance misuse (including alcohol) or multiple psychoactive drug use.

“GPs care for the whole patient and more than any other area of medical practice, we have the opportunity to develop long-term relationships with our patients. This means we are well placed to help our patients make appropriate choices,” Dr Jones said.

“The RACGP is very pleased and proud to be one of the medical colleges leading this important initiative.”