Top POEMs of 2018 Consistent with the Principles of the Choosing Wisely Campaign

摘要

In this article, we discuss the POEMs (patient-oriented evidence that matters) of 2018 judged to be most consistent with the principles of the Choosing Wisely campaign. We selected these POEMs through a crowdsourcing strategy of the daily POEMs information service for Canadian Medical Association's physician members. We present recommendations from these top POEMs of primary research or meta-analysis that identify interventions to consider avoiding in practice. The recommendations cover musculoskeletal conditions (e.g., avoid decompression surgery for treatment of subacromial shoulder pain), respiratory disease (in mild asthma, do not routinely prescribe a long-term daily inhaled steroid over the as-needed use of budesonide/formotera, infections (e.g., in children with acute respiratory tract infection, do not routinely prescribe broad-spectrum antibiotics over narrow-spectrum antibiotics), and cardiovascular disease (e.g., avoid blanket testing of cardiac troponin in patients with a low pretest likelihood of myocardial infarction). These POEMs describe interventions whose benefits are not superior to other options, are sometimes more expensive, or put patients at increased risk of harm. Knowing more about these POEMs and their connection with the Choosing Wisely campaign will help clinicians and their patients engage in conversations better informed by high-quality evidence. (C) Copyright 2019 American Academy of Family Physicians.