Login to Access Video or Poster Abstract: MP32-11
Sources of Funding: AUA Data Services Grant 2015

Introduction

The Choosing Wisely campaign was developed to reduce low value care practices. Specific (and overlapping) recommendations were released by both the American Urologic Association (in 2013), and the Canadian Urologic Association (CUA, in 2014), however the ability of this campaign to change physician behavior is unknown. The objective of this study was to determine if there was an increase in testosterone testing prior to supplementation, and a decrease in the use of Bone Scans in the evaluation of low risk prostate cancer patients, in accordance with the recommendations.

Methods

Several valid and reliable administrative data sources from Ontario, Canada were used. First, a cohort of men ≥66 years of age who received their first prescription for testosterone supplementation between April 2008 to March 2016 were identified. The primary outcome was the proportion of men undergoing a serum testosterone level in the 90 days prior to their prescription. Second, a cohort of men with a new diagnosis of prostate cancer between April 2008 and July 2015 were identified. The primary outcome was the proportion of men undergoing a Bone Scan 90 days after prostate cancer diagnosis. Piece-wise linear regression was used to evaluate for a significant change after the intervention date of November 2014 (date of CUA Choosing Wisely Campaign). Medians and interquartile range (IQR) are reported.

Results

We identified 11,496 men who had their initial prescription for testosterone filled during the specified time period. The median age was 71 (IQR 68-76), and the majority of prescriptions were provided by family physicians (66%). At the beginning of the study period, serum testosterone measured in an estimated 43% of men, and this increased in the pre-intervention time period by 0.2% per month; there was no significant change in this trend after Nov 2014 (p=0.27)._x000D_ _x000D_ We identified 60,209 men with a new diagnosis of prostate cancer. The median age was 67 (IQR 61-74), and approximately 2/3 were stage 1 or 2. At the beginning of the study period, bone scans were performed in an estimated 18% of men undergoing active surveillance, and this decreased by 0.05% per month in the pre-intervention time period; there was no significant change in this trend after Nov 2014 (p=0.07). _x000D_

Conclusions

In Ontario, there was no evidence of a significant change in two practice patterns that were subject of the Choosing Wisely Urology recommendations. Further mechanisms for translating these and future recommendations into behavior change may be necessary.

Funding

AUA Data Services Grant 2015