Table 1

Choosing Wisely programme summaries

Country	Name and goal	Current status	Organising group	Role of physician/healthcare provider Role of patient	Funder	Special issues
Australia	Choosing Wisely Australia facilitate dialogue between health professionals and patients about improving quality of care through reduction in unnecessary tests, treatments and procedures	Planning and implementation stages: First wave of lists currently in development in anticipation of 2015 launch Stakeholder engagement ongoing Advisory group to inform on longer term strategy for implementation and evaluation	NPS MedicineWise (http://www.nps.org.au)	Plan to have physicians and patients lead with NPS MedicineWise playing facilitator role (akin to American Board of Internal Medicine (ABIM) Foundation)	Government grant to NPS MedicineWise to support quality use of diagnostics	Federated government structure means hospital funding is via the states and primary care funding via the federal government Emphasis on evaluating impacts of the programme to measure effectiveness of the campaign Strong emphasis on demonstrating evidence to support recommendations
Canada	Choosing Wisely Canada help physicians and patients engage in conversations about unnecessary tests, treatments and procedures, and to help physicians and patients make smart and effective choices to ensure high-quality care	Launched nine national specialty societies in April 2014 Additional 25 plus societies in progress with release of second wave recommendations in October 2014	Choosing Wisely Canada (based at University of Toronto) is partnering with the Canadian Medical Association	General practitioners (GPs)/family physicians and specialty societies creating and disseminating lists Engaging large patient groups (ie, Patients Canada) to endorse and disseminate Advertising to public	Mixed funding (Government of Ontario, Canadian Medical Association, University of Toronto)	Healthcare is delivered provincially; choosing Wisely Canada is national
Denmark	N/A	Not planned presently. recent survey of specialties showed quite limited interest in Choosing Wisely process	N/A	N/A	N/A	Danish Health and Medicines Authority, Danish Medical Societies and five Danish regions are continuously developing national guidelines and measuring on clinical indicators
England	Probably Choosing Wisely	Planning stage with launch early 2015	The Academy of Medical Royal Colleges (AoMRC) A Steering Group is to be established involving key stakeholders to guide the programme This will comprise colleges, clinicians, patient groups, BMJ, commissioners, providers	Medical Royal Colleges and Specialist Societies will develop lists with an expectation of patient involvement at all stages National Voices, the coordinating body for patient groups, will be a co-partner NHS England wish to engage in the process but would not lead it	AoMRC Potentially NHS England	The National Institute for Clinical Effectiveness has extensive history of guideline products including 1000 recommendations on a 'do not do' database AoMRC has published a report about waste in clinical care The intention would be for all lists to collate together into a single database or document Despite large databases and high-quality evidence recommendation, practice does not align
Germany	Facilitate dialogue about value-based healthcare, inform the public and facilitate transfer of priority recommendations of high-quality guidelines into practice	Planning stages Working group on Choosing Wisely established based on the Initiative of the German Network for Evidence Based Medicine Annual guideline conference of the Association of the Scientific Medical Societies (AWMF) to discuss potential benefits, risks and implementability of a campaign as a complementary tool to transfer guidelines into practice in November 2014	AWMF (http://www.awmf.org) AWMF has a 20-year history of coordinating and supporting the guideline activities of its 168 member societies and runs a quality managed guideline register AWMF-Institute for Medical Knowledge Management (AWMF-IMWi) takes on responsibility for these tasks on the operational level	Guideline developing Scientific Medical Societies to take leadership key Plan to engage multidisciplinary guideline development groups including representatives of healthcare providers as well as patient representatives	At the beginning self-funding of the AWMF and its member societies on a small scale— later to be determined, additional funding will need to be sought for	Building on existing efforts of multidisciplinary guideline groups (including representatives of patients and other health professions) to give shape to a German Choosing Wisely initiative Topic-related approach, based on existing evidence-based, multidisciplinary guidelines Plan to address 'don't do' as well as 'do' recommendations based on a systematic process of criteria-driven priority setting The development of a manual /generic method report is in progress
Italy	‘Doing more does not mean doing better’ launched by Italy's Slow Medicine Primary goal is culture change—‘doing more does not mean doing better’ Improve quality and appropriateness of care and ensure patient safety through reduction of tests and treatments; decrease harm; promote partnership	Campaign launched December 2012 25 specialty physician and nurse societies engaged 10 Italian lists done Now in implementation stage	Board of Italy's Slow Medicine, with the collaboration of: National Federation of Medical Doctors and Dentists; National Federation of Nurses’ Colleges; Society for Quality in Healthcare; Altroconsumo and other patients and public organisations	Medical and nurse societies creating and disseminating lists Altroconsumo and other patients and public organisations developing patient materials and disseminating lists and culture	Italy's Slow Medicine, an independent organisation, is funded partly by medical societies Seeking funding	Part of the broader goal of Italy's Slow Medicine has three components including measured (doing more does not mean doing better), respectful (patient values) and equitable care (appropriate and good quality of care for all) Early implementation with Italian Society of General Practitioners in Piedmont region
Japan	Choosing Wisely—Japan Top have Japanese medical professionals and public be aware of current overuse of expensive diagnostic and therapeutic measures and to encourage change	Planning stages Using recommendations from Choosing Wisely and BMJ ‘Too Much Medicine Series’ Dissemination through publication and conferences A booklet in Japanese language entitled, ‘Choosing Wisely in Japan—Less is More’ which includes 26 ‘Lists of Five’ from US specialty societies has been published The contributors of the publication have proposed their list of five applicable to Japanese setting Creating working groups in primary care and specialty care societies	Establishment of a subcommittee in Japan Primary Care Association (JPCA) Collaboration of JPCA and Japanese Chapter of American College of Physicians, and eventually with Japanese Society of Internal Medicine	Medical specialty plus primary care group leading Patient engagement in planning stages	Volunteering	Conflict of interest of university clinical researchers with pharmaceutical industry has recently been publicised by media
Netherlands	Choosing Wisely—The Netherlands Improve quality of care by geographical measuring of unnecessary treatments; eliminating unproven treatments; searching for knowledge gaps in effectiveness; creating value by helping physicians and patients make wise(r) choices	Launched October 2012 14 medical societies actively involved (29 endorsed) Creating Dutch lists based on Choosing Wisely 6 scientific societies created lists of wise choices, most of them did already base that on evidence maps of practice variation	Dutch Association of Medical Specialists and Netherlands Organization for Health Research and Development Dutch Patient and Consumer Organization is partner	Physician led	Funds dedicated to quality for medical specialist care in the Netherlands Netherlands Organization for Health Research and Development (a non-governmental organisation)	Organisation covers four pillars of campaign include Wise Choices; measuring clinical practice variation; knowledge gaps by effectiveness research; shared decision making Drawback: Although Medical Specialist Societies did successfully create this campaign, covered by insurance companies and patient organisations GPs are not involved yet
New Zealand	To deliver better value for money in health services	Planning stages Adopting Choosing Wisely to engage physicians in two conditions (chronic obstructive pulmonary disease and ischaemic heart disease) Clinical working groups on these topics	National Health Committee (NHC) Government Health Technology Assessment organisation. Makes recommendations to Minister of Health	Physicians input solicited by NHC Work open for public comment	Government
Switzerland	Smarter Medicine To reduce care that brings no or little benefit, causes side effects, or increasing cost	Launched May 2014 Top 5 list for ambulatory care general internal medicine complete	Swiss Society of Internal Medicine Contact with consumer organisation for partnership	Medical society led. Patients not engaged yet	Swiss Society of Internal Medicine	Swiss Society of Internal Medicine funded two research projects on overuse
USA	Choosing Wisely To foster conversation between physicians and patients about unnecessary care Campaign focuses on physician professionalism and leadership	Launched in 2012 60 medical societies created lists Major distribution to patients and public through patient material Implementation in a variety of healthcare settings	ABIM Foundation and Consumer Reports	Physician led Patient/public education	ABIM Foundation Consumer Reports Robert Wood Johnson Foundation	Implementation is distributed across many types of organisations (network to learn from one another) Some societies have not chosen robust recommendations Regarded as highly successful but not measuring use (20% of all US physicians know about Choosing Wisely)
Wales	Prudent Healthcare To ensure patients receive the best care from available resources	Planning phase based on Bevan Commission ‘Prudent Healthcare Report’ (2013) and Provisional Principles 2014 Early stakeholder engagement re: Choosing Wisely. Workshop on four topics to test principles	Bevan Commission is independent Prudent Healthcare has Ministerial support	Being developed	Government	Early stages Have to align with existing organisations and recommendations (National Institute of Health and Care Excellence (NICE) recommendations, etc)