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In 2011, the Ontario College of family physicians (OCFP) developed a workshop entitled ‘Don’t Just Do Something, Stand There’. This workshop for primary care physicians quickly became very popular. It focused on helping them negotiate age-appropriate screening options and address different health topics without medicalizing patients or turning healthy people into sick people. The workshop was revamped and further elaborated in 2016 and is now given in most provinces in Canada. The focus is the same as the previous workshop but it aims to be even more practical and to give more tools to family doctors so they feel able to apply what they learned in daily practice. It aims to give them the ability to have what are sometimes difficult or complex conversations with their patients, and to practice shared-decision making. The workshop consists of four 1 h30 modules introducing a reflection on overimaging, overprescribing, cancer screening and overmonitoring of disease. The themes covered are as follows: imaging for low back pain and ovarian cysts, prescribing PPI and statins in primary care, screening for prostate cancer, breast cancer and colon cancer, the evidence-based periodic health visit, monitoring diabetes, deprescribing in the elderly and communication with the patient on issues of overuse. The workshop begins with a reflection on the impact of ‘too much medicine’ and continues through the topic via different clinical scenarios. Participants are guided through the cases and given different web sites and resources to explore in each section. Tutors make participants work in small and large groups to reflect on their own practice. We surveyed the participants before the workshop and at 6 and 12 weeks after the workshop specifically asking them if they had changed certain practices and if so which one. If they didn’t we tried to identify the barriers they encountered. If they did we ask them to describe their experience and also their perception of the patients’ reaction to these changes. The goal of our presentation is to inform, share and discuss our results while reflecting on our experience. Quebec is the Canadian province that has given the most workshops in 2017 and the demand for the workshops is sustained. Objectives Give an outline of the workshop Share the results of the feedback given by participants as well as the impacts described in the participants answers Review which general themes seem to have greater retention in our participants, and which themes remain more challenging to address. Method For each workshop, the participants filled a questionnaire before and immediately after the workshop. They also had to choose two practices they would change and after 6 and 12 weeks, they were asked to provide us with feedback using structured and semi-structured questions on their successes or challenges. We analyzed the responses to these questionnaires. We used quantitative measures when appropriate and analysed recurrent themes on answers asking them to describe how they were successful and/or the difficulties encountered in changing practices. Results Feedback was in general very favourable to this workshop, and most participants reported having used the tools and concepts that were discussed during the workshop. Many themes that can lead to overuse are discussed through the workshop. We have seen that deprescribing PPIs, shared decision making for statins in primary prevention and cancer screening counselling seem to be the practice change chosen the most often by participants. Some logistical issues are viewed as barriers but also, contradicting opinions by specialist colleagues can sometimes make applying what was learned difficult. It seems though, as per the participant’s feedback, that patients appreciate these changes. Conclusions We present Quebec’s experience with ‘Practicing Wisely’ a hands-on workshop aimed at decreasing overuse. We opted, which is different than in other provinces, to ask about practice changes in a descriptive manner, trying to better qualify successes and identify barriers. Our future goal is to prepare tools and material to address issues raised, so we can make the next version of the workshop even more relevant and useful. We believe such an interactive workshop, based on small and large group discussions, simple but common clinical scenarios, and use while in session of different resources is one possible (albeit one of many) way to help change in practice at the consultation level. |
