EVOLVE: The Australian Rheumatology Association’s ‘top five’ list of investigations and interventions doctors and patients should question

• DOI: 10.1111/imj.13654
• Publication Date: 2017-10-28T07:42:38Z
• Authors: Kathleen Morrisroe; Ayano Nakayama; Jason Soon; Mark Arnold; Les Barnsley; Claire Barrett; Peter M. Brooks; Stephen Hall; Patrick Hanrahan; Pravin Hissaria; Graeme Jones; Veera S. Katikireddi; Helen Keen; Rodger Laurent; Mandana Nikpour; Katherine Poulsen; Philip Robinson; Muriel Soden; Nigel Wood; Nicola Cook; Catherine Hill; Rachelle Buchbinder
• Keywords: Male; Diagnostic Tests, Routine; evidence-based practice; low-value care; rheumatology; Australia; 610; 3. Good health; EVOLVE; 03 medical and health sciences; 0302 clinical medicine; Rheumatology; 2724 Internal Medicine; Early Medical Intervention; Physicians; Rheumatic Diseases; 616; Practice Guidelines as Topic; Humans; Female; implementation

The EVOLVE (evaluating evidence, enhancing efficiencies) initiative aims to drive safer, higher-quality patient care through identifying and reducing low-value practices.To determine the Australian Rheumatology Association's (ARA) 'top five' list of practices.A working group comprising 19 rheumatologists three trainees compiled a preliminary list. Items were retained if there was strong evidence low value high or increasing clinical use and/or cost. All ARA members (356 72 trainees) invited indicate their from 12-items SurveyMonkey in December 2015 (reminder February 2016).A total 179 (50.3%) (26.4%) responded. top five (percentage rheumatologists, including item list) was: Do not perform arthroscopy with lavage debridement for symptomatic osteoarthritis knee nor partial meniscectomy degenerate meniscal tear (73.2%); order anti-nuclear antibody (ANA) testing without symptoms signs suggestive systemic rheumatic disease (56.4%); undertake imaging back pain patients indications an underlying serious condition (50.8%); ultrasound guidance injections into subacromial space as it provides no additional benefit comparison landmark-guided injection anti-double-stranded DNA antibodies ANA negative unless suspicion lupus erythematosus remains (45.3%).This is intended increase awareness among other clinicians about commonly used practices that should be questioned.