Article

Launched in the US in 2012, Choosing Wisely((R)) is a campaign
promoted by the American Board of Internal Medicine (ABIM) Foundation with the
goal of improving healthcare effectiveness by avoiding wasteful or unnecessary
medical tests, treatments and procedures. It uses concise recommendations
produced by national medical societies to start discussions between physicians
and patients on the relevance
of these services as part of a shared
decision-making process.
The Multiple Sclerosis Focus Group (Groupe de Reflexion
Autour de la Sclerose en Plaques; GRESEP) undertook a pilot study to assess the
relevance and feasibility of this approach in the management of multiple
sclerosis (MS) in France. METHODS: Recommendations were developed using the
formal consensus method from the guidelines of the French National Health
Authority (HAS). A steering committee selected the themes and drafted concise
evidence reviews. An independent rating group then assessed these recommendations
for clarity, relevance and feasibility. RESULTS: Seven recommendations were
accepted: (1) avoid systematic ordering of multimodal evoked potential studies
for diagnosing MS; (2) do not treat MS relapses with low-dose oral
corticosteroids; (3) when treating MS relapse with high-dose corticosteroids, the
systematic use of the intravenous route is unnecessary if the oral route can be
used; (4) systematic hospitalization is not necessary for treating MS relapse
with high-dose corticosteroid therapy, particularly if the oral route is used,
except for the first treated relapse and the presence of exclusion or
non-eligibility criteria; (5) in the absence of clinical signs or symptoms of
urinary infection, avoid systematic screening with urine microscopy and culture
before the administration of corticosteroid therapy for MS relapse in patients
using intermittent self-catheterization; (6) avoid antibiotic treatment of
clinically asymptomatic MS patients using intermittent self-catheterization, even
if urine microscopy and culture reveal the presence of microorganisms; and (7)
avoid introducing symptomatic drug treatment for MS-related fatigue. CONCLUSION:
This pilot study, the first of its kind in France, has demonstrated the relevance
and feasibility of adapting the Choosing Wisely((R)) model to MS by practitioners
specializing in the disorder. However, the acceptability of these recommendations
by other practitioners in other specialist fields as well as their impact on
everyday clinical practices now need to be studied.
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Langue : ANGLAIS