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Many patients with COPD use inhaled corticosteroids (ICS) without proper indication. We developed a multifaceted tailor-made de-implementation strategy—including a toolbox, communication plan, and training—to reduce inappropriate ICS use in general practice. We evaluated its effectiveness (i.e. decline in percentage of patients with COPD that use ICS) and other outcomes during a 15-month study in Drenthe, the Netherlands. Less patients (−4.7%,95%CI: 2.6–6.7%) used ICS at the end of follow-up and the percentage of ICS-users declined by 8.2% (95%CI: 2.9–13.4%) across the 14 practices that fully participated in the project. ICS user percentages declined significantly moreover time in the fully participation group than in the control group (beta-regression, β = −0.041,SE = 0.011, p  < 0.01). While these findings are promising, further research is needed to assess additional penetration and sustainability of the strategy in the region and to explore the applicability of comparable regional ICS de-implementation plans.

New approaches are needed to advance the aims of Choosing Wisely and reduce overuse in practice, argue Karen Born and colleagues

Choosing Wisely (CW) campaigns globally have focused attention on the need to reduce low-value care, which can represent up to 30% of the costs of healthcare. Despite early enthusiasm for the CW initiative, few large-scale changes in rates of low-value care have been reported since the launch of these campaigns. Recent commentaries suggest that the focus of the campaign should be on implementation of evidence-based strategies to effectively reduce low-value care. This paper describes the Choosing Wisely De-Implementation Framework (CWDIF), a novel framework that builds on previous work in the field of implementation science and proposes a comprehensive approach to systematically reduce low-value care in both hospital and community settings and advance the science of de-implementation.The CWDIF consists of five phases: Phase 0, identification of potential areas of low-value healthcare; Phase 1, identification of local priorities for implementation of CW recommendations; Phase 2, identification of barriers to implementing CW recommendations and potential interventions to overcome these; Phase 3, rigorous evaluations of CW implementation programmes; Phase 4, spread of effective CW implementation programmes. We provide a worked example of applying the CWDIF to develop and evaluate an implementation programme to reduce unnecessary preoperative testing in healthy patients undergoing low-risk surgeries and to further develop the evidence base to reduce low-value care.

BackgroundLow-value care does not benefit the patient and may in fact lead to potential harms, be more costly and not reflect preferences of the patient. Low-value care can be reduced by targeted interventions, also called de-implementation interventions. While evidence exists about how to implement evidence-based practices in general, there has been less attention focused on the challenge of implementing recommendations to reduce low-value healthcare. After a de-implementation intervention is designed and successful at reducing low-value care, even less is known about how interventions can be disseminated to other organizations.Research teams in Canada and the Netherlands in collaboration with Choosing Wisely International have developed tools and frameworks to assist in the design and evaluation of de-implementation interventions. In addition, we have developed a framework of determinants to consider when planning to scale and disseminate effective de-implementation interventions. This workshop will be an opportunity to share our knowledge and experience, stimulate the interaction to using the developed frameworks for reducing low-value care, and to share the experiences and views of the audience of the workshop.AimsThe aims of this workshop are:To present the theoretical background on de-implementation and dissemination, guided with frameworks and examples of successful large scale de-implementation interventions and dissemination projects.To provide opportunities for a group in how to design a dissemination strategy.MethodThe workshop will consist of three parts:We will go stepwise through all phases of de-implementation: from identification of potential low-value healthcare to identification of local priorities and barriers, designing interventions to overcome barriers, evaluation of the interventions and spread of effective de-implementations.We will provide examples of successful large scale de-implementation and dissemination projects from Canada and the Netherlands, such as inappropriate vitamin testing in primary care, and laboratory testing and pre-operative testing in hospitals. We will provide examples on how to consider the determinants from a dissemination framework and targeted those that were relevant and those we could influence. Because of the differences in setting and context, the strategies differed among the projects.The audience will be working on the design of their own dissemination plan and share their knowledge and experience. During this part of the workshop, we will select a few initiatives that are of interest of the audience. In smaller groups the audience will design a dissemination strategy of the selected initiatives. These strategies will be presented to the audience.ResultsParticipants will gain knowledge of all phases of de-implementation. They will have knowledge about influencing factors that are of specific importance for disseminating de-implementation interventions. The participants will have the opportunity to share their own ideas and experiences and receive feedback from the public. This information can be used for tackling the factors in the development of their own de-implementation and dissemination projects.