Looking at selected medical tests, treatments and procedures in Canada, a new report finds that up to 30% of them are potentially unnecessary. The report Unnecessary Care in Canada, released by the Canadian Institute for Health Information (CIHI) and Choosing Wisely Canada, uses data to measure the extent of unnecessary care associated with 8 tests and procedures that span the health system.

A joint effort from the Canadian Institute of Health Information (CIHI) and Choosing Wisely Canada has revealed that there are more than one million unnecessary tests and treatments administered to patients across the country every year.

The groups looked at eight specific tests and treatments and found that about 30% of them weren’t conducted according to Choosing Wisely Canada recommendations and, thus, were likely unnecessary. These included:

  • Conducting imaging for lower back pain and minor head trauma when no red flags are present
  • Obtaining head CT scans in hospitalized patients with delirium (in absence of other risk factors)
  • Routine mammography screening for average-risk women between the ages of 40 and 49
  • The use of atypical antipsychotics as a first-line intervention for insomnia in children and youth
  • The use of benzodiazepines in older adults as the first choice of treatment for insomnia, agitation and delirium
  • Preoperative testing before low-risk surgeries
  • Transfusing blood when patients hit certain arbitrary thresholds in the absence of symptoms, active coronary disease, heart failure, or stroke

“By setting a baseline for measuring these several recommendations, we can see that there is room to improve care for patients and eliminate waste,” said Dr. Wendy Levinson, Chair, Choosing Wisely Canada, and a professor of medicine at the University of Toronto.

“All clinicians want to provide the best quality of care for their patients. With this report, we can now see noticeable regional- and facility-level data that identifies opportunities for improvement and reinforces the concern over resource stewardship across the country.”

The report found that in Alberta, for instance, 30% of patients with lower back pain (but no red flags) received an X-ray, CT scan or MRI. Between 18% and 35% of patients in Ontario, Saskatchewan and Alberta underwent preoperative testing before a low-risk procedure. Twenty-two per cent of Canadian women at average risk in the 40-49 age bracket received a screening mammogram, and 30% of ER patients in Ontario and Alberta with a low-risk minor head trauma received a CT head scan.

Not only do unnecessary tests or treatments place additional financial strain on the health system, but they can occasionally be harmful for patients. The side-effects of prescribing benzodiazepines, for example, become more severe in older adults—increased risk of accidents, falls and fractures—and usually outweigh potential benefits.

Overtesting can also have trickle-down effects like in breast cancer screening. To save one woman who would have died from the disease, 2,100 average-risk women (ages 40-49) would need to be screened every two years for 11 years, producing 700 false positives, 75 unnecessary biopsies and 10 unnecessary mastectomies or lumpectomies that come as a result of misdiagnosis.

The report also highlighted a number of efforts to cut down on this unnecessary testing. For example, Health Quality Ontario regularly updates and distributes figures about unwarranted pre-operative testing to every hospital, tracking the numbers right down to the hospital level.

You can view the full report to learn more.

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