POEMs of 2022 aligned with CWC recommendations
| POEM TITLE | RECOMMENDATION (SOURCE) | TOOL KIT |
|---|---|---|
| Hypnotic agents are effective for insomnia but at the expense of adverse effects3 | Do not use benzodiazepines or other sedative-hypnotics in older adults as first choice for insomnia, agitation, or delirium (Canadian Geriatrics Society)4 | CWC’s primary care5 and hospital6 tool kits indicate how to reduce unnecessary benzodiazepine use in older adults |
| NICE guidance: type 2 diabetes (2022)3 | Avoid using medications known to cause hypoglycemia to achieve hemoglobin A1c <7.5% in many adults aged 65 and older; moderate control is generally better (Canadian Geriatrics Society)4 | None |
| Do not recommend routine or multiple daily self-glucose monitoring in adults with stable type 2 diabetes on agents that do not cause hypoglycemia (Canadian Society of Endocrinology and Metabolism)7 | ||
| Postoperative opioids are no better for pain relief and cause more adverse effects than nonopioids3 | Prolonged use of opioid analgesia beyond the immediate postoperative period or other acute pain episode is not recommended (Canadian Association of General Surgeons)8 | Opioid Wisely CWC campaign provides recommendations and patient resources for reducing unnecessary opioid prescribing9 |
| Comparable postoperative pain relief for opioid- and nonopioid-based regimens following ACL reconstruction3 | Do not initiate opioids long term for chronic pain until there has been a trial of available nonpharmacologic treatments and adequate trials of nonopioid medications10 | None |
| Only some musculoskeletal conditions benefit from surgery3 | Do not use arthroscopic debridement as a primary treatment in the management of osteoarthritis of the knee (Canadian Orthopaedic Association; Canadian Arthroplasty Society; Arthroscopy Association of Canada)11 | None |
| Do not perform fusion surgery to treat patients with mechanical axial low back pain from multilevel spine degeneration in the absence of: (a) leg pain with or without neurologic symptoms and/or signs of concordant neurologic compression, and (b) structural pathology such as spondylolisthesis or deformity (Canadian Spine Society)12 | ||
| Tight control associated with more frequent and persistent hypoglycemia in elderly persons with diabetes mellitus3 | Avoid using medications known to cause hypoglycemia to achieve hemoglobin A1c <7.5% in many adults aged 65 and older; moderate control is generally better (Canadian Geriatrics Society)4 | None |
| Amoxicillin for children with CAP: low dose for 3 days is noninferior to high dose for 7 days3 | These 3 POEMs align with CWC’s Using Antibiotics Wisely campaign13 | CWC Cold Standard tool kit provides tools for reducing unnecessary antibiotics14 |
| Comparable outcomes with 5 days and 10 days of antibiotics in children with CAP3 | ||
| Point-of-care testing for respiratory pathogens does not reduce antibiotic use or improve outcomes3 | ||
| Proton pump inhibitor use associated with an increased risk of gastric cancer3 | These 2 POEMs align with the following CWC recommendation: Do not maintain long-term PPI therapy for gastrointestinal symptoms without an attempt to stop or reduce PPI at least once per year in most patients15 | CWC’s tool kit provides tools for deprescribing PPIs16 |
| American College of Gastroenterology guideline for diagnosing and managing GERD3 | ||
| Screening colonoscopies are overused3 | Avoid colorectal cancer screening tests in asymptomatic patients with a life expectancy of less than 10 years and with no personal or family history of colorectal neoplasia (Canadian Association of General Surgeons)8 | None |
| Urine collection devices do not reduce contamination in women with suspected urinary tract infections3 | Do not use a bag for collection of urine cultures to diagnose urinary tract infections (Association of Medical Microbiology and Infectious Disease Canada)17 | None |
| White blood cells do not equate to bacterial cells in the urine of hospitalized patients3 | Do not do a urine dip test or send urine specimens for culture unless urinary tract symptoms are present (Canadian Nurses Association and Infection Prevention and Control Canada)18 | None |
| Antibiotics for asymptomatic bacteriuria in residents of aged care facilities: bacteriologic, but not clinical, cure; more adverse events3 | Linked to this POEM are 9 recommendations to reduce unnecessary antibiotic use for asymptomatic bacteriuria13 | Using Antibiotics Wisely in long-term care CWC recommendation provides information on reducing unnecessary antibiotic use for asymptomatic bacteriuria13 |
| A high-sensitivity troponin T level less than 6 ng/L is very good at ruling out myocardial infarction or death in the next 30 days3 | Do not test for myoglobin or creatine kinase MB in the diagnosis of acute myocardial infarction. Instead, use troponin I or T (Canadian Cardiovascular Society)19 | None |
| Neither vitamin D nor omega-3 fatty acid supplementation reduce the risk of frailty3 | Do not routinely measure vitamin D in low-risk adults (College of Family Physicians of Canada)10 | None |
| NICE guidelines on treatment of depression3 | Do not routinely use antidepressants as first-line treatment for mild or subsyndromal depressive symptoms in adults (Canadian Academy of Child and Adolescent Psychiatry; Canadian Academy of Geriatric Psychiatry; Canadian Psychiatric Association)20 | None |
ACL—anterior cruciate ligament, CAP—community-acquired pneumonia, CWC—Choosing Wisely Canada, GERD—gastroesophageal reflux disease, NICE—National Institute for Health and Care Excellence, POEM—Patient-Oriented Evidence that Matters, PPI—proton pump inhibitor.