Evidence map›Paper›PMID 36735223›Full record

ArticleCMAJ open

The impact of the Choosing Wisely Canada campaign on the simultaneous use of angiotensin-converting-enzyme inhibitors and angiotensin receptor blockers: interrupted time-series analysis.

Tracey-Lea Laba, Heather C Worthington, Lucy Cheng, Fiona K I Chan, Nick Bansback, Michael R Law

Open access · diamondAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in CMAJ open. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
0.3field-weighted citation impact, top 34% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed, 1 citations in OpenAlex.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors at 2 institutions in 2 countries.

Tracey-Lea LabaPharmacy Program (Laba), Clinical and Health Sciences Unit, The University of South Australia, Adelaide, Australia; The Centre for Health Economics Research and Evaluation (Laba), University of Technology Sydney, Ultimo, Australia; Centre for Health Services and Policy Research (Worthington, Chen, Bansback, Law), School of Population and Public Health, University of British Columbia, Vancouver, BC; Department of Epidemiology, Biostatistics, and Occupational Health (Chan), McGill University, Montréal, Que. tracey.laba@unisa.edu.au.
Heather C WorthingtonPharmacy Program (Laba), Clinical and Health Sciences Unit, The University of South Australia, Adelaide, Australia; The Centre for Health Economics Research and Evaluation (Laba), University of Technology Sydney, Ultimo, Australia; Centre for Health Services and Policy Research (Worthington, Chen, Bansback, Law), School of Population and Public Health, University of British Columbia, Vancouver, BC; Department of Epidemiology, Biostatistics, and Occupational Health (Chan), McGill University, Montréal, Que.
Lucy ChengPharmacy Program (Laba), Clinical and Health Sciences Unit, The University of South Australia, Adelaide, Australia; The Centre for Health Economics Research and Evaluation (Laba), University of Technology Sydney, Ultimo, Australia; Centre for Health Services and Policy Research (Worthington, Chen, Bansback, Law), School of Population and Public Health, University of British Columbia, Vancouver, BC; Department of Epidemiology, Biostatistics, and Occupational Health (Chan), McGill University, Montréal, Que.
Fiona K I ChanPharmacy Program (Laba), Clinical and Health Sciences Unit, The University of South Australia, Adelaide, Australia; The Centre for Health Economics Research and Evaluation (Laba), University of Technology Sydney, Ultimo, Australia; Centre for Health Services and Policy Research (Worthington, Chen, Bansback, Law), School of Population and Public Health, University of British Columbia, Vancouver, BC; Department of Epidemiology, Biostatistics, and Occupational Health (Chan), McGill University, Montréal, Que.
Nick BansbackPharmacy Program (Laba), Clinical and Health Sciences Unit, The University of South Australia, Adelaide, Australia; The Centre for Health Economics Research and Evaluation (Laba), University of Technology Sydney, Ultimo, Australia; Centre for Health Services and Policy Research (Worthington, Chen, Bansback, Law), School of Population and Public Health, University of British Columbia, Vancouver, BC; Department of Epidemiology, Biostatistics, and Occupational Health (Chan), McGill University, Montréal, Que.
Michael R LawPharmacy Program (Laba), Clinical and Health Sciences Unit, The University of South Australia, Adelaide, Australia; The Centre for Health Economics Research and Evaluation (Laba), University of Technology Sydney, Ultimo, Australia; Centre for Health Services and Policy Research (Worthington, Chen, Bansback, Law), School of Population and Public Health, University of British Columbia, Vancouver, BC; Department of Epidemiology, Biostatistics, and Occupational Health (Chan), McGill University, Montréal, Que.
University of British Columbia · CAUniversity of South Australia · AU

Funding

CIHR FDN-148412
6 · The paper itself

Abstract

backgroundChoosing Wisely is a high-profile campaign seeking to reduce the use of low-value care. We investigated the impact of a Choosing Wisely Canada recommendation against using a combination of angiotensin-converting-enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) for the management of hypertension, heart failure or diabetic nephropathy on population-level use of these medications in British Columbia, Canada.

methodsWe identified all people (any age) who were continuously registered with BC's Medical Service Plan between 2010 and 2017 with the targeted conditions. Using prescription claims data and an interrupted time-series analysis, we estimated the number of people on combination therapy per month, the proportion of days covered (PDC) by combination therapy per month and proportion of all combination prescriptions started per month in the 2 years before and after the introduction of the recommendation on Oct. 29, 2014.

resultsOf 1 104 593 people (mean age 65 yr, standard deviation 16 yr) in our study cohort, 4.6% were exposed to combination therapy, largely prescribed by family physicians (84%). The number of people on combination therapy and the PDC were declining before the recommendation, but the proportion of combination prescriptions started in the 2 years before the recommendation was increasing. After the recommendation, we observed no statistically significant changes in any outcome. The pre-existing downward trend of the monthly number of people decelerated (16.8, 95% confidence interval [CI] 14.0 to 19.5) and the proportion of prescriptions started increased (0.13%, 95% CI 0.08% to 0.18%).

interpretationThe Choosing Wisely Canada recommendation against using a combination of ACE inhibitors and ARBs was not associated with reduced combination therapy use in the targeted conditions. The observed pre-existing declines in this practice questions the process of selecting recommendations, and the optimal implementation and value of Choosing Wisely campaigns without other reinforcing interventions.

Indexed as

Angiotensin-Converting Enzyme InhibitorsHypertensionAgedAngiotensin Receptor AntagonistsAngiotensinsBritish ColumbiaHumansAngiotensin-Converting Enzyme InhibitorsAngiotensin Receptor AntagonistsAngiotensins

Identifiers

PMID36735223
PMCPMC9828945
OpenAlexW4312419839

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.