Shirley L Chow1, J Carter Thorne2, Mary J Bell2, Robert Ferrari2, Zarnaz Bagheri2, Tristan Boyd2, Ann Marie Colwill2, Michelle Jung2, Damian Frackowiak2, Glen S Hazlewood2, Bindee Kuriya2, Peter Tugwell. 1. From the Division of Rheumatology, Department of Medicine, University of Toronto, Toronto; Southlake Regional Health Centre, Newmarket; Division of Rheumatology, Department of Medicine, Western University, London; Division of Rheumatology, Department of Medicine, University of Ottawa, Ottawa, Ontario; Department of Medicine and Department of Rheumatic Diseases, University of Alberta, Edmonton; Division of Rheumatology, Department of Medicine, University of Calgary, Calgary, Alberta; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.S.L. Chow, MD; M.J. Bell, MD; Z. Bagheri, MD; D. Frackowiak, MD; B. Kuriya, MD, Division of Rheumatology, Department of Medicine, University of Toronto; J.C. Thorne, MD, Southlake Regional Health Centre; R. Ferrari, MD, Department of Medicine and Department of Rheumatic Diseases, University of Alberta; T. Boyd, MD; M. Jung, MD, Division of Rheumatology, Department of Medicine, Western University; A.M. Colwill, MD, Division of Rheumatology, Department of Medicine, University of British Columbia; G.S. Hazlewood, MD, Division of Rheumatology, Department of Medicine, University of Calgary; P. Tugwell, MD, Division of Rheumatology, Department of Medicine, University of Ottawa. Shirley.Chow@sunnybrook.ca. 2. From the Division of Rheumatology, Department of Medicine, University of Toronto, Toronto; Southlake Regional Health Centre, Newmarket; Division of Rheumatology, Department of Medicine, Western University, London; Division of Rheumatology, Department of Medicine, University of Ottawa, Ottawa, Ontario; Department of Medicine and Department of Rheumatic Diseases, University of Alberta, Edmonton; Division of Rheumatology, Department of Medicine, University of Calgary, Calgary, Alberta; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.S.L. Chow, MD; M.J. Bell, MD; Z. Bagheri, MD; D. Frackowiak, MD; B. Kuriya, MD, Division of Rheumatology, Department of Medicine, University of Toronto; J.C. Thorne, MD, Southlake Regional Health Centre; R. Ferrari, MD, Department of Medicine and Department of Rheumatic Diseases, University of Alberta; T. Boyd, MD; M. Jung, MD, Division of Rheumatology, Department of Medicine, Western University; A.M. Colwill, MD, Division of Rheumatology, Department of Medicine, University of British Columbia; G.S. Hazlewood, MD, Division of Rheumatology, Department of Medicine, University of Calgary; P. Tugwell, MD, Division of Rheumatology, Department of Medicine, University of Ottawa.
Abstract
OBJECTIVE: To develop a list of 5 tests or treatments used in rheumatology that have evidence indicating that they may be unnecessary and thus should be reevaluated by rheumatology healthcare providers and patients. METHODS: Using the Delphi method, a committee of 16 rheumatologists from across Canada and an allied health professional generated a list of tests, procedures, or treatments in rheumatology that may be unnecessary, nonspecific, or insensitive. Items with high content agreement and perceived relevance advanced to a survey of Canadian Rheumatology Association (CRA) members. CRA members ranked these top items based on content agreement, effect, and item ranking. A methodology subcommittee discussed the items in light of their relevance to rheumatology, potential effect on patients, and the member survey results. Five candidate items selected were then subjected to a literature review. A group of patient collaborators with rheumatic diseases also reviewed these items. RESULTS: Sixty-four unique items were proposed and after 3 Delphi rounds, this list was narrowed down to 13 items. In the member-wide survey, 172 rheumatologists responded (36% of those contacted). The respondent characteristics were similar to the membership at large in terms of sex and geographical distribution. Five topics (antinuclear antibodies testing, HLA-B27 testing, bone density testing, bone scans, and bisphosphonate use) with high ratings on agreement and effect were chosen for literature review. CONCLUSION: The list of 5 items has identified starting points to promote discussion about practices that should be questioned to assist rheumatology healthcare providers in delivering high-quality care.
OBJECTIVE: To develop a list of 5 tests or treatments used in rheumatology that have evidence indicating that they may be unnecessary and thus should be reevaluated by rheumatology healthcare providers and patients. METHODS: Using the Delphi method, a committee of 16 rheumatologists from across Canada and an allied health professional generated a list of tests, procedures, or treatments in rheumatology that may be unnecessary, nonspecific, or insensitive. Items with high content agreement and perceived relevance advanced to a survey of Canadian Rheumatology Association (CRA) members. CRA members ranked these top items based on content agreement, effect, and item ranking. A methodology subcommittee discussed the items in light of their relevance to rheumatology, potential effect on patients, and the member survey results. Five candidate items selected were then subjected to a literature review. A group of patient collaborators with rheumatic diseases also reviewed these items. RESULTS: Sixty-four unique items were proposed and after 3 Delphi rounds, this list was narrowed down to 13 items. In the member-wide survey, 172 rheumatologists responded (36% of those contacted). The respondent characteristics were similar to the membership at large in terms of sex and geographical distribution. Five topics (antinuclear antibodies testing, HLA-B27 testing, bone density testing, bone scans, and bisphosphonate use) with high ratings on agreement and effect were chosen for literature review. CONCLUSION: The list of 5 items has identified starting points to promote discussion about practices that should be questioned to assist rheumatology healthcare providers in delivering high-quality care.
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Keywords:
CLINICAL PRACTICE GUIDELINE; COST-BENEFIT ANALYSIS; COST-EFFECTIVENESS; RHEUMATOLOGY
Authors: Ciara Pendrith; Meghan Bhatia; Noah M Ivers; Graham Mecredy; Karen Tu; Gillian A Hawker; Susan B Jaglal; Lynn Wilson; Kimberly Wintemute; Richard H Glazier; Wendy Levinson; R Sacha Bhatia Journal: CMAJ Open Date: 2017-01-20
Authors: Nathan Peiffer-Smadja; Adeline Bauvois; Marie Chilles; Baptiste Gramont; Redwan Maatoug; Marie Bismut; Camille Thorey; Eric Oziol; Thomas Hanslik Journal: J Gen Intern Med Date: 2019-06-12 Impact factor: 5.128