Guidance issued on providing high-value, low-carbon care
The Canadian Society of Internal Medicine and Choosing Wisely Canada recently released eight recommendations for climate-friendly care aimed at general internal medicine physicians.
A recent position paper from the Canadian Society of Internal Medicine (CSIM) and Choosing Wisely Canada offers guidance for general internal medicine physicians to stop or reduce tests, treatments, and procedures that do not benefit patients and harm the environment.
The recommendations were drafted by the CSIM's planetary health task force with and refined after feedback from CSIM membership and expert review by the planetary health panel of Choosing Wisely Canada. They were published by the Journal of General Internal Medicine on Feb. 27.
The following are the final eight recommendations:
- 1. Do not prescribe IV antibiotics for patients who can safely be treated with an oral option.
- 2. Do not prescribe heparin or low-molecular-weight heparin when oral options are effective, preferred by the patient, and felt to be safe by the prescriber.
- 3. Do not prescribe greenhouse gas-intensive metered-dose inhalers if a greener alternative with comparable efficacy is available, technique is adequate, and patient preference has been considered.
- 4. Do not recommend or order investigations or interventions before discussing patients' expected trajectory of health and life expectancy and exploring their goals of care.
- 5. Do not continue medications without confirming their clinical indications, particularly for sedative medications, proton-pump inhibitors, and inhalers.
- 6. Do not order daily blood tests on hospitalized patients if it will not change management.
- 7. Do not use nonsterile disposable gloves when hand hygiene is sufficient.
- 8. Do not schedule in-person follow-up appointments when a virtual visit is clinically appropriate and is preferred by the patient.
The paper noted that the recommendations were developed in Canada but were informed by worldwide evidence. “Choosing Wisely campaigns have a proven track record of inspiring meaningful practice change internationally which gives confidence that these climate-focused recommendations can be successfully implemented outside Canada,” the authors wrote. “Future work should focus on the dissemination and implementation of these recommendations through quality improvement projects, incorporation into hospital and health system accreditation standards and strategic plans, and integration into continuing medical education and trainee education.”