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Reducing low value care: opportunities and challenges for Choosing Wisely campaigns
  1. Jeremy M Grimshaw1,2,
  2. Wendy Levinson3,4
  1. 1Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
  2. 2Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
  3. 3Department of Medicine, University of Toronto, Toronto, Ontario, Canada
  4. 4St. Michael’s Hospital, Toronto, Ontario, Canada
  1. Correspondence to Dr Jeremy M Grimshaw, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; jgrimshaw{at}

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Low value care harms patients (due to adverse events of treatments or secondary unwarranted tests), overburdens healthcare professionals (potentially contributing to burnout), threatens healthcare systems (threatening sustainability due to inefficient use of scarce healthcare resources) and damages the climate (due to negative environmental impact on provision of low value care).1 Low value care is a global phenomenon affecting both high-resource and low-resource settings (and if anything is more harmful in low-resource settings). While the problem of low value care has been recognised for many years, until recently it received insufficient attention.

Choosing Wisely (CW) was founded a decade ago in the USA and initially focused on clinician engagement to raise awareness of the problems of low value care and its negative impacts. It aims to change healthcare professional culture making stewardship of healthcare resources a professional responsibility.2 CW spread rapidly and CW (and similar) campaigns are now common globally.3 CW campaigns have initially used a bottom-up approach developing partnerships with professional associations (initially engaging with physicians’ associations but rapidly spreading to involve other healthcare professional groups) to identify lists of low value care that could be stopped without adverse consequences.

Perhaps one of CW’s earliest findings was that low value care practices are pervasive across all of healthcare. CW campaigns encouraged healthcare professionals to engage patients in conversations about unnecessary tests, treatments and procedures and to help patients make smart and effective choices to ensure high-quality care. They have used a wide range of approaches to promote awareness and de-implementation of low value care, including practical tools for clinicians and guidance (eg, a series published in BMJ on how to implement CW recommendations: Also, given that patterns of practice are established early in training and persist through practice lifetime, CW campaigns have also engaged with healthcare …

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  • Contributors Both authors conceived this paper. JMG wrote the first draft. WL commented on successive drafts. Both authors approved the final version of the paper.

  • Funding This study was funded by the Canadian Institutes of Health Research (grant numbers: MYG-158642, FDN-143269).

  • Competing interests WL is the lead of Choosing Wisely Canada. JMG is the Implementation Research Lead for Choosing Wisely Canada. JMG and WL are Principal Investigators of the research programme highlighted in box 2 and co-investigators on the BE-SAFE project.

  • Provenance and peer review Commissioned; externally peer reviewed.