Top POEMs of 2019 Consistent with the Principles of the Choosing Wisely Campaign
Am Fam Physician. 2020 Dec 1;102(11):673-678.
Published online October 30, 2020.
Author disclosure: Dr. Grad has no relevant financial affiliations. Dr. Ebell is cofounder and editor-in-chief of Essential Evidence Plus; see Editor's Note.
In this article, we discuss the POEMs (patient-oriented evidence that matters) of 2019 judged to be most consistent with the principles of Choosing Wisely, an international campaign to reduce unnecessary testing and treatments. We selected these POEMs through a crowdsourcing strategy of the daily POEMs information service for the Canadian Medical Association's physician members. We present recommendations from these top POEMs of primary research or meta-analysis that identify interventions to encourage or consider avoiding in practice. The recommendations cover musculoskeletal conditions (e.g., do not recommend platelet-rich plasma injections for rotator cuff disease or knee osteoarthritis), respiratory disease (e.g., in clinically stable patients with community-acquired pneumonia, antibiotics can be stopped after five days), screening or preventive care (e.g., patients who take their blood pressure at home or in a pharmacy should know what to do when they have an elevated reading), and miscellaneous topics (e.g., in healthy adults treated for dermatophyte infection, do not obtain baseline or follow-up alanine transaminase level, aspartate transaminase level, or complete blood count). 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 patients engage in conversations better informed by high-quality evidence.
The coronavirus disease 2019 (COVID-19) pandemic has left its mark. Perhaps more than ever, we understand the importance of implementing the principles of the Choosing Wisely campaign in clinical practice to improve resource stewardship. Since 2016, articles in this series have highlighted POEMs (patient-oriented evidence that matters) as sparks to change practice, in line with the principles of the Choosing Wisely campaign.1 POEMs are synopses of research studies that report patient-oriented outcomes, such as improvement in symptoms, quality of life, or mortality. They describe studies that are free of important methodologic bias and recommend a change in practice for many physicians. In this article, we discuss the daily POEMs of 2019 that were judged to be most consistent with principles of the Choosing Wisely campaign, an international effort to reduce unnecessary medical tests, treatments, and procedures. Rather than having experts select the top POEMs, we use a crowd-sourcing method to identify new studies about clinical actions most consistent with Choosing Wisely, from the perspective of the physician in everyday practice.2
In brief, our crowdsourcing method to identify the top POEMs consistent with the Choosing Wisely campaign is based on ratings of the daily POEM delivered to physicians in a CME program. In 2019, we received an average of 1,530 physician ratings for each of the 254 POEMs delivered to members of the Canadian Medical Association. As identified by these physicians, we present the top POEMs of 2019 whose findings can help to reduce overdiagnosis or overtreatment in clinical practice.
Eleven of the top research studies of 2019 also ranked near the top for Choosing Wisely.3 Because these POEMs were summarized earlier this year in a related article, we do not rediscuss them here. However, to highlight their importance, POEMs on these studies are summarized in eTable A. In addition, all articles in the top POEMs series are available at https://www.aafp.org/afp/toppoems.
Additional Top POEMs from 2019 Consistent with the Principles of the Choosing Wisely Campaign
|Clinical question||Bottom-line answer||Clinical actions to consider for Choosing Wisely|
In patients with acute pain, does a higher dose of ibuprofen produce greater pain relief?A1
Higher doses of ibuprofen for acute pain relief offer no more benefit at 60 minutes than a single 400-mg dose. The same has been shown for chronic treatment of osteoarthritis; an anti-inflammatory dose is not needed. Furthermore, another study showed equivalence between 200-mg and 400-mg doses of ibuprofen.
For pain relief, a 400-mg dose of ibuprofen works as well as higher doses.
What signs and symptoms are most useful for excluding the diagnosis of pneumonia in community-dwelling adults with an acute respiratory infection?A2
Community-dwelling adults who present as outpatients with symptoms of acute respiratory tract infection but normal vital signs and normal findings on a pulmonary examination have only a 0.4% likelihood of community-acquired pneumonia.
The combination of normal vital signs and normal lung examination findings essentially rules out community-acquired pneumonia.
Does low-dose aspirin prevent cardiovascular events and cardiovascular-related death in otherwise healthy older people?A3
Low-dose aspirin does not reduce the
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