To Choose or Not To Choose: Evaluating the Effect of a Choosing Wisely Knowledge Translation Initiative for Imaging in Low Back Pain by Emergency Physicians.

Authors:
Kavish Chandra
Kavish Chandra
Mount Allison University
Paul R Atkinson
Paul R Atkinson
Dalhousie University
Canada
Jacqueline Fraser
Jacqueline Fraser
Saint John Regional Hospital ; Emergency Medicine
Cherie Lee Adams
Cherie Lee Adams
Saint John Regional Hospital

Cureus 2019 Feb 4;11(2):e4002. Epub 2019 Feb 4.

Emergency Medicine, Saint John Regional Hospital, Saint John, CAN.

Introduction: We aimed to quantify the baseline familiarity of emergency medicine (EM) physicians with the Choosing Wisely Canada (CWC)-EM recommendations. We then assessed whether a structured knowledge translation (KT) initiative affected awareness, knowledge, and practice patterns for imaging in low back pain.

Methods: We completed a two-center, before and after practice evaluation study. Physicians working in two Canadian emergency departments (EDs) were asked to participate in a survey before a KT initiative, and were surveyed again at a six-month follow up period post-intervention. The primary outcome of physician practice was determined by analyzing the frequency of lumbar X-ray imaging for back pain.

Results: A total of 37 physicians were asked to complete the pre- and post-intervention survey. Awareness of the CWC-EM recommendations increased following the intervention (63%; 95%CI: 43-79 at baseline vs. 86%; 66-96 post-intervention). Knowledge increased with 58% (39-76) of physicians responding correctly initially, and 86% (66-96) after the intervention. Despite increases in awareness and knowledge of the guidelines, the lumbar X-ray imaging rate increased from a baseline of 12% (9.9-14.5) to 16.2% (13.6-19.2; p = 0.023) following the intervention.

Conclusion: We demonstrated some improvements in physician awareness and knowledge of the CWC-EM recommendations following our intervention. Despite these improvements, our KT intervention was associated with an increased frequency of imaging for low back pain, contrary to our expectations.

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Source
http://dx.doi.org/10.7759/cureus.4002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6447138PMC
February 2019
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