Skip to main content

Main menu

  • Home
  • Articles
    • Current
    • Published Ahead of Print
    • Archive
    • Supplemental Issues
    • Collections - French
    • Collections - English
  • Info for
    • Authors & Reviewers
    • Submit a Manuscript
    • Advertisers
    • Careers & Locums
    • Subscribers
    • Permissions
  • About CFP
    • About CFP
    • About the CFPC
    • Editorial Advisory Board
    • Terms of Use
    • Contact Us
  • Feedback
    • Feedback
    • Rapid Responses
    • Most Read
    • Most Cited
    • Email Alerts
  • Blogs
    • Latest Blogs
    • Blog Guidelines
    • Directives pour les blogues
  • Mainpro+ Credits
    • About Mainpro+
    • Member Login
    • Instructions
  • Other Publications
    • http://www.cfpc.ca/Canadianfamilyphysician/
    • https://www.cfpc.ca/Login/
    • Careers and Locums

User menu

  • My alerts

Search

  • Advanced search
The College of Family Physicians of Canada
  • Other Publications
    • http://www.cfpc.ca/Canadianfamilyphysician/
    • https://www.cfpc.ca/Login/
    • Careers and Locums
  • My alerts
The College of Family Physicians of Canada

Advanced Search

  • Home
  • Articles
    • Current
    • Published Ahead of Print
    • Archive
    • Supplemental Issues
    • Collections - French
    • Collections - English
  • Info for
    • Authors & Reviewers
    • Submit a Manuscript
    • Advertisers
    • Careers & Locums
    • Subscribers
    • Permissions
  • About CFP
    • About CFP
    • About the CFPC
    • Editorial Advisory Board
    • Terms of Use
    • Contact Us
  • Feedback
    • Feedback
    • Rapid Responses
    • Most Read
    • Most Cited
    • Email Alerts
  • Blogs
    • Latest Blogs
    • Blog Guidelines
    • Directives pour les blogues
  • Mainpro+ Credits
    • About Mainpro+
    • Member Login
    • Instructions
  • RSS feeds
  • Follow cfp Template on Twitter
OtherPractice

Choosing Wisely Canada recommendations

Stephanie Klein and Dana Mayer
Canadian Family Physician November 2017, 63 (11) e473;
Stephanie Klein
Co-Chief Resident at North York General Hospital in Toronto, Ont.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Dana Mayer
Resident at North York General Hospital in Toronto, Ont.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • eLetters
  • Info & Metrics
  • PDF
Loading

Hospital medicine recommendation 3
Geriatric medicine recommendation 2
Psychiatry recommendation 13

Do not use benzodiazepines or other sedative-hypnotics in older adults as first-choice treatment for insomnia, agitation, or delirium.

Psychiatry recommendation 9

Do not routinely continue benzodiazepines initiated during an acute-care hospital admission without a careful review and plan for tapering and discontinuing, ideally before hospital discharge.

How have you implemented these recommendations in your practice?

We did our resident quality improvement project on deprescribing chronic benzodiazepines in the elderly. This coincided with the development of a sleep program at our family health team (FHT), where pharmacists helped patients taper sedative-hypnotic drugs, and social workers ran a cognitive-behavioural therapy group for insomnia.

We identified patients using an electronic medical record search for benzodiazepines prescribed within the past year for those older than age 65. Chart reviews were used to identify the reason for the prescription and the length of use. We focused on patients who took the medication for 3 months or longer for insomnia or mild anxiety, or for whom the prescription was not evidence based.

We then contacted eligible patients by telephone or at their next appointment to discuss the harms of chronic benzodiazepine use and invite them to taper their doses. If interested, they were provided with the deprescribing tool for benzodiazepines created by Dr Cara Tannenbaum and colleagues.1

For some patients, the tool was enough for them to start tapering. If more support was needed, we referred them to the FHT sleep program. We would periodically follow up to see if they needed additional support.

To date, 62% of the patients we engaged in the pilot study have reduced their dose or tapered off completely.

How have you brought the Choosing Wisely principles to your relationship with patients?

Several Choosing Wisely Canada recommendations address overprescribing. These conversations are not always easy, but there are opportunities that lend themselves to a medication review. For example, if a patient who is dependent on benzodiazepines has a fall, he or she might be open to discussing the possibility of tapering. Or, during a periodic health review, if the patient still feels he or she is not getting restful sleep, he or she might be open to a risk-benefit discussion. Most patients do not know that benzodiazepines only add an average of 23 extra minutes of sleep per night.2 Most also do not know the risks of taking them, such as daytime sedation, falls, hip fractures, impaired cognition, and car accidents.

In our project, we recognized we were not here to tell patients what to do, or to push their limits. One of the most important parts of family medicine is building a trusting, long-standing relationship with patients. We want to empower our patients and know that they are considering deprescribing based on their own decisions. We used motivational interviewing to understand why people believed they needed the medication. We also addressed sleep myths (eg, how many hours people need to function).

What does Choosing Wisely mean to you as family physicians in training?

In medical school, you are expected to learn all tests and treatments relevant to managing your patients’ care. Over time, you home in on what is appropriate—this is an art. In our residency, the Choosing Wisely principles are central to the way we practise. We always ask ourselves, What will I get from these test results? Will it change the treatment and potentially the outcome? Choosing Wisely provides support to challenge the notion that “more is better,” to be introspective about the care we provide, and to think critically.

To us, Choosing Wisely also means working collaboratively with our interprofessional team. We would not be able to implement quality improvement initiatives if it were not for the members of the North York FHT coming together to provide integrated, patient-centred care.

Notes

Choosing Wisely Canada

Choosing Wisely Canada is a campaign to help clinicians and patients engage in conversations about unnecessary tests, treatments, and procedures, and to help physicians and patients make smart and effective choices to ensure high-quality care. To date there have been 11 family medicine recommendations, but many of the recommendations from other specialties are relevant to family medicine. In each installment of the Choosing Wisely Canada series in Canadian Family Physician, a family physician is interviewed about how he or she has implemented one of the recommendations in his or her own practice. The interviews are prepared by Dr Kimberly Wintemute, Primary Care Co-Lead, and Hayley Thompson, Project Coordinator, for Choosing Wisely Canada.

  • Copyright© the College of Family Physicians of Canada

References

  1. 1.↵
    1. Tannenbaum C,
    2. Ahmed S,
    3. Benedetti A,
    4. Tamblyn R
    . EMPOWER trial—empowering older adults to reduce benzodiazepine use. Ottawa, ON: Bruyère Research Institute; Available from: https://goo.gl/upxnna. Accessed 2017 Sep 25.
  2. 2.↵
    1. Glass J,
    2. Lanctôt KL,
    3. Herrmann N,
    4. Sproule BA,
    5. Busto UE
    . Sedative hypnotics in older people with insomnia: meta-analysis of risks and benefits. BMJ 2005;331(7526):1169.
    OpenUrlAbstract/FREE Full Text
PreviousNext
Back to top

In this issue

Canadian Family Physician: 63 (11)
Canadian Family Physician
Vol. 63, Issue 11
1 Nov 2017
  • Table of Contents
  • About the Cover
  • Index by author
Print
Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Email Article

Thank you for your interest in spreading the word on The College of Family Physicians of Canada.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Choosing Wisely Canada recommendations
(Your Name) has sent you a message from The College of Family Physicians of Canada
(Your Name) thought you would like to see the The College of Family Physicians of Canada web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Choosing Wisely Canada recommendations
Stephanie Klein, Dana Mayer
Canadian Family Physician Nov 2017, 63 (11) e473;

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Respond to this article
Share
Choosing Wisely Canada recommendations
Stephanie Klein, Dana Mayer
Canadian Family Physician Nov 2017, 63 (11) e473;
del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • Hospital medicine recommendation 3Geriatric medicine recommendation 2Psychiatry recommendation 13
    • Psychiatry recommendation 9
    • How have you implemented these recommendations in your practice?
    • How have you brought the Choosing Wisely principles to your relationship with patients?
    • What does Choosing Wisely mean to you as family physicians in training?
    • Notes
    • References
  • Info & Metrics
  • eLetters
  • PDF

Related Articles

  • No related articles found.
  • PubMed
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

Practice

  • Is 45 the new 50 in colorectal cancer screening?
  • Approach to diagnosis and management of childhood attention deficit hyperactivity disorder
  • Determining if and how older patients can safely stay at home with additional services
Show more Practice

Choosing Wisely Canada

  • Diagnosing asthma and chronic obstructive pulmonary disease
  • Rethinking a history of recurrent urinary tract infections
  • Ordering investigations after hours
Show more Choosing Wisely Canada

Similar Articles

Navigate

  • Home
  • Current Issue
  • Archive
  • Collections - English
  • Collections - Française

For Authors

  • Authors and Reviewers
  • Submit a Manuscript
  • Permissions
  • Terms of Use

General Information

  • About CFP
  • About the CFPC
  • Advertisers
  • Careers & Locums
  • Editorial Advisory Board
  • Subscribers

Journal Services

  • Email Alerts
  • Twitter
  • RSS Feeds

Copyright © 2022 by The College of Family Physicians of Canada

Powered by HighWire