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In this blog, Dr Charlotte Sharp talks about the Choosing Wisely UK recommendations, which our members gave guidance for, and how those in rheumatology can implement them.


The British Society for Rheumatology’s (BSR’s) six Choosing Wisely UK recommendations were launched at the Academy of Medical Royal Colleges in June 2018. Choosing Wisely UK is part of a global initiative to promote shared decision making and help people choose care that is supported by evidence, not duplicative, free from harm and consistent with their values.


By improving conversations between doctors and patients, Choosing Wisely UK aims to reduce the overuse of tests, procedures and treatments, with resultant reduction in patient burden, administration for clinicians and the opportunity to make the most of available resources.


Our recommendations


The BSR’s list includes recommendations regarding the use of immunology testing (ANA & ENA, complement C3/C4 & double-stranded DNA), vitamin D testing, as well as bisphosphonate therapy and steroid injections for non-inflammatory musculoskeletal conditions.


They are directed at rheumatologists, physicians from other specialties, GPs, nurses, allied health professionals and patients, and were developed with a multi-disciplinary working group which included all these stakeholders. The team have since been busy publicizing the recommendations in the hope that clinicians and allied health professionals will use them to empower patients to embrace shared decision making, and to ensure that resources are directed to interventions with the most benefit.


Our patient contributor, Karen Staniland, wrote a piece for the National Rheumatoid Arthritis Society’s members’ magazines which was published in September 2018, along with an equivalent piece for healthcare professionals. Dr Charlotte Sharp and Dr Lizzy MacPhie, who led the recommendations’ development, collaborated with the Arthritis and Musculoskeletal Alliance and NHS England to deliver a webinar, attended by 40 CCG managers and healthcare professionals, and since viewed a further 135 times on YouTube.


The webinar explains how the recommendations were developed, what they contain, and how they can be implemented in practice. Other outputs include letters in Clinical Medicine, and presentations to the Primary Care Rheumatology Society, Leaders in Healthcare Conferences, and a national immunology conference.


The next challenge is to for us all to embed the recommendations into our daily practice. We can do this by raising awareness of the recommendations amongst colleagues, using them as education and training tools for teaching interventions, and as the basis for quality improvement interventions.


Quality improvement interventions might include simple reminders, patient education, or collaboration with your immunology colleagues to change order sets, alter comments on requests and introduce pop-up reminders. These interventions are likely to have a greater impact if they are developed in collaboration with the people that they will affect, and if stakeholders are reminded about them over time.


To hear more, come along to the conference session “Impact and Implementation”, where Charlotte Sharp will be using the development of the Choosing Wisely recommendations as a case study of stakeholder engagement and co-production (0900 Wednesday 1 May, Hall 9), or to the President’s Picks poster presentation at 1115 Wednesday 1 May.


You can read our recommendations, along with those of the other colleges and societies, on the Choosing Wisely UK website, or download them here