A new initiative directed by the American Board of Internal Medicine, known as Choosing Wisely, presents a compilation of 415 evidence-based recommendations to ensure the safest and most effective treatments for patients. The primary target of this list was for the practitioners who diagnose and prescribe to target identified problems of underuse, overuse, and misuse of therapies and diagnostic testing. Once the recommendations were reviewed, it was found that 110 were related to the use of medications and drug classes. The most popular classes addressed were antimicrobials, pain management, neurologic, anticoagulants, and oncology medications.
After reviewing the recommendations, pharmacists supported the proposed list, but also looked to determine their own set of recommendations that could be of value to the patients they serve. One proposed pharmacy recommendation suggests not prescribing medication to patients older than 65 already, who are already on 5 or more medications without a comprehensive medication review of existing medications. Another states, “Do not initiate medications to treat symptoms, adverse events, or side effects without determining if an existing therapy is the cause and whether a dosage reduction.” The goal of defining a set of recommendations for pharmacists is to ensure that patients are on therapies that are indicated, effective, and safe in treating their health conditions.
The program, Choosing Wisely, is important for pharmacists to be aware of in order to have active participation with the entire healthcare team. By knowing the recommendations that other providers are using, we can understand their reasoning behind diagnosis and treatment decisions. Pharmacists can also serve as a check-point to determine if the correct recommendation has been followed before dispensing the prescribed medication. Further, the idea of pharmacists defining their own set of practice recommendations is very interesting. From reading the proposed ideas, it is easy to see the need and the benefit that these implementations can have on patient health. However, having two separate recommendations lists could get confusing for pharmacists to reference. If pharmacists were able to merge their own recommendations with with already existing Choosing Wisely list, I think it would optimize healthcare decisions and allow for a more streamlined process for communication within the interprofessional team.
Am J Health-Syst Pharm. 2015;72: 1529-1530.