Royal Australasian College of Physicians

Evolve

Better care. Better decision-making. Better use of resources.


What is Evolve?

Part of a global movement, Evolve is an initiative led by physicians and the Royal Australasian College of Physicians (RACP) to drive high-value, high-quality care in Australia and New Zealand. Through a rigorous peer-review process, Evolve identifies a specialty’s Top 5 clinical practices that, in particular circumstances, may be overused, provide little or no benefit, or cause unnecessary harm. Evolve aims to:

  • safely and responsibly phase out low-value tests, treatments and procedures where appropriate
  • support physicians in providing high-value care to patients based on evidence and expertise
  • provide a trusted process for each specialty to remain up-to-date with the latest evidence
  • enable physicians to influence the best use of health resources, reducing wasted expenditure
  • ensure patients receive the test, treatment or procedure they need.

RACP is a founding member of Choosing Wisely in Australia and New Zealand. By bringing together recommendations from multiple medical colleges and healthcare organisations, together with expertise in consumer and patient care, Choosing Wisely helps healthcare providers and consumers start important conversations about improving the quality of healthcare.

All RACP specialty societies are invited to develop their Top 5 List of low-value practices. The Australian & New Zealand Society of Geriatric Medicine (ANZSGM) is currently implementing their recommendations across specialties, health services and in clinical practice.

  • Do not use antipsychotics as the first choice to treat behavioural and psychological symptoms of dementia
  • Do not prescribe benzodiazepines or other sedative-hypnotics to older adults as first choice for insomnia, agitation or delirium
  • Do not use antimicrobials to treat bacteriuria in older adults where specific urinary tract symptoms are not present
  • Do not prescribe medication without conducting a drug regimen review
  • Do not use physical restraints to manage behavioural symptoms of hospitalised older adults with delirium except as a last resort.

Implementation

RACP encourages its Advanced Trainees and Fellows to develop and conduct research on the Evolve recommendations as part of specialty training. RACP is currently undertaking two Advanced Trainee Evolve Demonstration Projects on the Australian & New Zealand Society of Geriatric Medicine’s Evolve Top 5 List items, which focus on high-risk medications, polypharmacy and de-prescribing.

 

Case Study
Dr Brendan J Ng, FRACP, USYD, RNSH

What was the issue?

Hospitalisation represents an opportunity to reduce inappropriate polypharmacy in older adults with multi-morbidity. This is not routinely addressed during admission, despite the increasing literature around deprescribing.

What did we do?

  • Identified barriers and enablers to deprescribing in clinicians are awareness, self-efficacy, clinical inertia and feasibility
  • The effectiveness of online educational modules to improve deprescribing of inappropriate polypharmacy remains unclear
  • This is part of a multi-factorial intervention aiming to reduce inappropriate polypharmacy in older inpatients and an RACP Evolve Trainee demonstration project which promotes:
    • ANZSGM Evolve Recommendation 2: Do not prescribe benzodiazepines or other sedative-hypnotics to older adults as first choice for insomnia, agitation or delirium
    • ANZSGM Evolve Recommendation 4: Do not prescribe medication without conducting a drug regimen review
  • For more information, visit evolve.edu.au/evolve-research or email evolve@racp.edu.au.