Evaluating the evidence for choosing Wisely™ in primary care using the Strength of Recommendation Taxonomy (SORT)

Objective: The goal of this study was to evaluate the quality of evidence supporting primary care-relevant Choosing WiselyTM recommendations using the Strength of Recommendation Taxonomy (SORT). Methods: All Choosing Wisely "top 5" lists published by American medical specialty societies through June 2014 were reviewed for relevance to primary care. Both authors independently applied SORT to generate an evidence letter grade for each of the included recommendations, relying on citations supplied by the nominating organizations. Results: Of 310 recommendations, 224 were identified as being relevant to primary care. We rated 43 (19%) as SORT level of evidence A, 57 (25%) as B, and 124 (55%) as C. Conclusion: We found that a majority of primary care-relevant Choosing Wisely recommendations are based on expert consensus or disease-oriented evidence. Further research is warranted to strengthen the evidence base supporting these recommendations in order to improve their acceptance and implementation into primary care.