{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T20:05:40Z","timestamp":1787169940914,"version":"build-2736575974"},"reference-count":15,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","license":[{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction:<\/jats:title>\n                    <jats:p>The COVID-19 pandemic significantly disrupted primary care delivery, amplifying challenges in resource stewardship. Choosing Wisely Canada (CWC) guidelines aim to reduce unnecessary interventions. However, barriers to their implementation persist, particularly in rural settings where access to resources is limited and patient expectations often conflict with evidence-based care. Our study explored primary care physicians\u2019 awareness of, utilisation of and barriers to implementing CWC guidelines in a post-pandemic context, focusing on challenges, quality improvement opportunities and innovative approaches to reduce low-value care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>An online survey of primary care physicians across Canada was used to collect demographic data, practice habits and perspectives on CWC guidelines. Quantitative analysis measured trends, while qualitative analysis of open-ended responses identified recurring themes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>One hundred and twenty-seven primary care physicians responded to the survey. Results revealed high awareness of CWC guidelines (97.6%) but low familiarity with post-pandemic adaptations (36.2%) and patient-facing materials (61.4%). Key barriers included time constraints, fear of missed diagnoses and limited rural resources. Physicians highlighted the need for tailored approaches in rural settings, where deviations from guidelines are often necessary because of challenges related to healthcare access. Participants identified several opportunities for improvement, including integrating guidelines into electronic medical records and developing mobile applications to support decision-making. Enhanced patient education emerged as critical for addressing demands for unnecessary tests, often fuelled by misinformation from social media.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Targeted medical and patient education, interprofessional collaboration and technology integration are essential for improving CWC adoption. Tailored solutions that address rural-specific challenges and systemic barriers are pivotal for achieving sustainable resource stewardship in primary care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Introduction:<\/jats:title>\n                    <jats:p>La pand\u00e9mie de COVID-19 a profond\u00e9ment boulevers\u00e9 l\u2019organisation des soins primaires, accentuant les d\u00e9fis li\u00e9s \u00e0 l\u2019utilisation judicieuse des ressources. Les recommandations de Choisir avec soin visent \u00e0 r\u00e9duire les interventions inutiles, mais leur mise en \u0153uvre demeure difficile, surtout en milieu rural o\u00f9 l\u2019acc\u00e8s aux services est restreint et o\u00f9 les attentes des patients s\u2019harmonisent parfois mal avec les pratiques fond\u00e9es sur les donn\u00e9es probantes. Notre \u00e9tude examine la connaissance, l\u2019utilisation et les obstacles \u00e0 l\u2019int\u00e9gration des recommandations de Choisir avec soin chez les m\u00e9decins de famille en contexte postpand\u00e9mique, en mettant l\u2019accent sur les d\u00e9fis rencontr\u00e9s, les occasions d\u2019am\u00e9lioration de la qualit\u00e9 des soins et les approches innovantes pour diminuer les actes \u00e0 faible valeur.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>M\u00e9thodes:<\/jats:title>\n                    <jats:p>Une enqu\u00eate en ligne a \u00e9t\u00e9 distribu\u00e9e \u00e0 des m\u00e9decins de soins primaires partout au Canada. Le questionnaire recueillait des donn\u00e9es d\u00e9mographiques, des informations sur les habitudes de pratique et des perceptions par rapport aux recommandations de Choisir avec soin. L\u2019analyse quantitative a permis d\u2019identifier les tendances, tandis que l\u2019analyse qualitative des r\u00e9ponses ouvertes a fait ressortir des th\u00e8mes r\u00e9currents.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>R\u00e9sultats:<\/jats:title>\n                    <jats:p>Cent vingt-sept m\u00e9decins y ont r\u00e9pondu. Bien que la grande majorit\u00e9 connaissait les recommandations de Choisir avec soin (97.6%), peu \u00e9taient au fait des adaptations postpand\u00e9miques (36.2%) ou des outils destin\u00e9s aux patients (61.4%). Les obstacles principaux mentionn\u00e9s incluaient le manque de temps, la crainte de passer \u00e0 c\u00f4t\u00e9 d\u2019un diagnostic important et le manque de ressources en r\u00e9gion. Les m\u00e9decins ont soulign\u00e9 la n\u00e9cessit\u00e9 d\u2019approches adapt\u00e9es aux r\u00e9alit\u00e9s rurales, o\u00f9 il faut parfois s\u2019\u00e9loigner des recommandations en raison de contraintes d\u2019acc\u00e8s aux services. Les participants ont \u00e9galement mis de l\u2019avant plusieurs pistes d\u2019am\u00e9lioration, comme l\u2019int\u00e9gration des recommandations dans les dossiers m\u00e9dicaux \u00e9lectroniques et la cr\u00e9ation d\u2019applications mobiles pour soutenir la prise de d\u00e9cision. Une meilleure \u00e9ducation des patients a \u00e9t\u00e9 identifi\u00e9e comme essentielle pour r\u00e9pondre aux demandes d\u2019examens inutiles, souvent aliment\u00e9es par la d\u00e9sinformation circulant sur les r\u00e9seaux sociaux.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Le renforcement de la formation clinique et de l\u2019\u00e9ducation du public, la collaboration interprofessionnelle et l\u2019int\u00e9gration de solutions technologiques sont essentiels pour augmenter l\u2019adoption des recommandations de Choisir avec soin. Des strat\u00e9gies adapt\u00e9es aux r\u00e9alit\u00e9s des milieux ruraux et aux obstacles syst\u00e9miques sont indispensables pour assurer une gestion durable et responsable des ressources en soins primaires.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/cjrm.cjrm_87_24","type":"journal-article","created":{"date-parts":[[2026,2,7]],"date-time":"2026-02-07T10:00:14Z","timestamp":1770458414000},"page":"7-14","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Improving resource stewardship in post-pandemic primary care: Insights into choosing Wisely Canada guidelines"],"prefix":"10.4103","volume":"31","author":[{"given":"Nathan","family":"Jeffery","sequence":"first","affiliation":[{"name":"Undergraduate Medical Education, Northern Ontario School of Medicine University, Sudbury, ON, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Div","family":"Patel","sequence":"additional","affiliation":[{"name":"Undergraduate Medical Education, Northern Ontario School of Medicine University, Sudbury, ON, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taylor","family":"Marshall","sequence":"additional","affiliation":[{"name":"Undergraduate Medical Education, Northern Ontario School of Medicine University, Sudbury, ON, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa","family":"Allen","sequence":"additional","affiliation":[{"name":"Huntsville Physicians Local Education Group, Huntsville, ON, Canada"},{"name":"South Muskoka Local Education Group, Bracebridge, ON, Canada"},{"name":"Parry Sound Local Education Group, Parry Sound, ON, Canada"},{"name":"Muskoka Algonquin Healthcare, Huntsville, ON, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roy","family":"Kirkpatrick","sequence":"additional","affiliation":[{"name":"Undergraduate Medical Education, Northern Ontario School of Medicine University, Sudbury, ON, Canada"},{"name":"Huntsville Physicians Local Education Group, Huntsville, ON, Canada"},{"name":"Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,2,9]]},"reference":[{"key":"R1-20260209","doi-asserted-by":"crossref","first-page":"100406","DOI":"10.1016\/j.jcpo.2023.100406","article-title":"Are the choosing wisely Canada cancer recommendations relevant and up to date with the current evidence?","volume":"35","author":"Karim","year":"2023","journal-title":"J Cancer Policy"},{"key":"R2-20260209","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1503\/cmaj.131674","article-title":"Engaging physicians and patients in conversations about unnecessary tests and procedures: Choosing Wisely Canada","volume":"186","author":"Levinson","year":"2014","journal-title":"CMAJ"},{"key":"R3-20260209","doi-asserted-by":"crossref","first-page":"3098","DOI":"10.1136\/bmj.g3098","article-title":"US doctors say unnecessary tests and procedures are a serious concern","volume":"348","author":"McCarthy","year":"2014","journal-title":"BMJ"},{"key":"R4-20260209","doi-asserted-by":"crossref","first-page":"850","DOI":"10.1002\/cam4.1925","article-title":"Do doctors who order more routine medical tests diagnose more cancers? A population-based study from Ontario Canada","volume":"8","author":"Hall","year":"2019","journal-title":"Cancer Med"},{"key":"R5-20260209","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1186\/s12961-018-0370-5","article-title":"Physician perspectives on choosing wisely Canada as an approach to reduce unnecessary medical care: A qualitative study","volume":"16","author":"Embrett","year":"2018","journal-title":"Health Res Policy Syst"},{"key":"R6-20260209","doi-asserted-by":"crossref","first-page":"e9","DOI":"10.2196\/jmir.5729","article-title":"Internet health information seeking and the patient-physician relationship: A systematic review","volume":"19","author":"Tan","year":"2017","journal-title":"J Med Internet Res"},{"key":"R7-20260209","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1111\/cag.12557","article-title":"Geographic accessibility to primary care providers: Comparing rural and urban areas in Southwestern Ontario","volume":"64","author":"Shah","year":"2020","journal-title":"Can Geogr"},{"key":"R8-20260209","doi-asserted-by":"crossref","first-page":"366","DOI":"10.3325\/cmj.2015.56.366","article-title":"Stressed and overworked? A cross-sectional study of the working situation of urban and rural general practitioners in Austria in the framework of the QUALICOPC project","volume":"56","author":"Hoffmann","year":"2015","journal-title":"Croat Med J"},{"key":"R9-20260209","doi-asserted-by":"crossref","first-page":"569","DOI":"10.1007\/s43678-022-00349-2","article-title":"Choosing wisely Canada: Scratching the 7-year itch","volume":"24","author":"Chen","year":"2022","journal-title":"CJEM"},{"key":"R10-20260209","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1186\/s13104-016-2103-6","article-title":"A survey of primary care patients' readiness to engage in the de-adoption practices recommended by choosing wisely Canada","volume":"9","author":"Silverstein","year":"2016","journal-title":"BMC Res Notes"},{"key":"R11-20260209","article-title":"Ontario Ministry of Health. Learn More About the Rurality Index for Ontario score","year":"2024","journal-title":"Government of Ontario"},{"key":"R12-20260209","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1191\/1478088706qp063oa","article-title":"Using thematic analysis in psychology","volume":"3","author":"Braun","year":"2006","journal-title":"Qual Res Psychol"},{"key":"R13-20260209","doi-asserted-by":"crossref","first-page":"e001576","DOI":"10.1136\/bmjph-2024-001576","article-title":"Impact of the COVID-19 pandemic on health services utilisation and mortality in Ontario, Canada: An interrupted time series analysis","volume":"3","author":"Saqib","year":"2025","journal-title":"BMJ Public Health"},{"key":"R14-20260209","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1186\/s12875-025-02868-0","article-title":"Reflections of rural primary care physicians on the impact of the COVID-19 pandemic: A qualitative study","volume":"26","author":"Henningfield","year":"2025","journal-title":"BMC Prim Care"},{"key":"R15-20260209","doi-asserted-by":"crossref","first-page":"E200","DOI":"10.1503\/cmaj.202303","article-title":"Shifts in office and virtual primary care during the early COVID-19 pandemic in Ontario, Canada","volume":"193","author":"Glazier","year":"2021","journal-title":"CMAJ"}],"container-title":["Canadian Journal of Rural Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/cjrm.cjrm_87_24","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T19:15:17Z","timestamp":1787166917000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/cjrm.cjrm_87_24"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":15,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.4103\/cjrm.cjrm_87_24","relation":{},"ISSN":["1203-7796","1488-237X"],"issn-type":[{"value":"1203-7796","type":"print"},{"value":"1488-237X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1]]},"assertion":[{"value":"2024-12-11","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-03-07","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}