Moderated Poster

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MP32-11: The impact of the Choosing Wisely campaign on low value urologic practises

Saturday, May 13
9:30 AM - 11:30 AM
Location: BCEC: Room 252

Presentation Authors: Blayne Welk*, Jennifer Winick-Ng, Andrew McClure, London, Canada, Girish Kulkarni, Michael Ordon, Toronto, Canada

Introduction: The Choosing Wisely campaign was developed to reduce low value care practices. Specific (and overlapping) recommendations were released by both the American Urologic Association (in 2013), and the Canadian Urologic Association (CUA, in 2014), however the ability of this campaign to change physician behavior is unknown. The objective of this study was to determine if there was an increase in testosterone testing prior to supplementation, and a decrease in the use of Bone Scans in the evaluation of low risk prostate cancer patients, in accordance with the recommendations.

Methods: Several valid and reliable administrative data sources from Ontario, Canada were used. First, a cohort of men ≥66 years of age who received their first prescription for testosterone supplementation between April 2008 to March 2016 were identified. The primary outcome was the proportion of men undergoing a serum testosterone level in the 90 days prior to their prescription. Second, a cohort of men with a new diagnosis of prostate cancer between April 2008 and July 2015 were identified. The primary outcome was the proportion of men undergoing a Bone Scan 90 days after prostate cancer diagnosis. Piece-wise linear regression was used to evaluate for a significant change after the intervention date of November 2014 (date of CUA Choosing Wisely Campaign). Medians and interquartile range (IQR) are reported.

Results: We identified 11,496 men who had their initial prescription for testosterone filled during the specified time period. The median age was 71 (IQR 68-76), and the majority of prescriptions were provided by family physicians (66%). At the beginning of the study period, serum testosterone measured in an estimated 43% of men, and this increased in the pre-intervention time period by 0.2% per month; there was no significant change in this trend after Nov 2014 (p=0.27).

We identified 60,209 men with a new diagnosis of prostate cancer. The median age was 67 (IQR 61-74), and approximately 2/3 were stage 1 or 2. At the beginning of the study period, bone scans were performed in an estimated 18% of men undergoing active surveillance, and this decreased by 0.05% per month in the pre-intervention time period; there was no significant change in this trend after Nov 2014 (p=0.07).


Conclusions: In Ontario, there was no evidence of a significant change in two practice patterns that were subject of the Choosing Wisely Urology recommendations. Further mechanisms for translating these and future recommendations into behavior change may be necessary.

Source Of Funding: AUA Data Services Grant 2015

Blayne Welk, MD MSc

Western University

Dr. Welk obtained his Bachelors of Science degree and Medical Degree at the University of Western Ontario. He then went on to complete his urology residency at the University of British Columbia and obtained his Royal College certification in Urology. He completed additional clinical training at the University of Toronto, where he specialized in the evaluation and treatment of male and female incontinence, male urethral stricture disease, and neurogenic bladder dysfunction. During his 2-year fellowship he also completed a Masters degree in Clinical Epidemiology at the University of Toronto.

In 2011 he was appointed as an Assistant Professor in the Department’s of Surgery (Urology) and subsequently cross-appointed to the Department of Epidemiology and Biostatistics at Western University. He has a busy tertiary referral practice covering all aspects of his fellowship training. He is an Adjunct Scientist at the Institute for Clinical Evaluative Sciences. He has received peer-reviewed grants from the Canadian Urologic Association, Academic Medical Organization of Southwestern Ontario, PSI Foundation, Rick Hansen Foundation, Society of Urodynamics, Female Pelvic Medicine, and Urogenital Reconstruction and Ontario Neurotrauma Foundation in order to support his research. He has published over 40 peer reviewed manuscripts in a variety of journals such as the Journal of Urology, BMJ, and JAMA Surgery.

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