The impact of the Choosing Wisely Campaign in urology

Objective — To determine if three of the Canadian Urological Association's Choosing Wisely recommendations (released in 2013-2014) related to urologic care altered physician and patient behavior.

Methods — Administrative data from Ontario, Canada between 2008-2017 was used. We identified three cohorts: First, we determined how men >66 years of age who had a serum testosterone level prior to starting testosterone therapy. Second, we determined how many boys undergoing an orchiopexy underwent abdominal imaging prior to their surgery. Third, we determined how many men with low risk prostate cancer underwent a Bone Scan after diagnosis. Piece-wise linear regression was used to evaluate for a significant change after Choosing Wisely.

Results — We identified 13,113 men who had their initial prescription for testosterone filled. Serum testosterone measurement increased over time, from approximately 43% to 68%. There were 9,319 boys who underwent an orchiopexy. The use of pre-orchiopexy ultrasound was generally stable (approximately 55%). We identified 27,174 men with low risk prostate cancer. The use of bone scans after diagnosis decreased over time from approximately 24% to 20%. In all three of these groups, there was no significant change after Choosing Wisely (p=0.74, p=0.70, p=0.72 respectively).

Conclusion — In Ontario, there was no evidence of a significant change in three practice patterns that were featured in Choosing Wisely Urology recommendations. Further thought may be needed on how to translate these and future recommendations into behavior change.