Abstract
BackgroundThrough the Choosing Wisely Canada (CWC) campaign, national medical specialty societies have released hundreds of recommendations against health care services that are unnecessary, i.e. present little to no benefit or cause avoidable harm. Despite growing interest in unnecessary care both within Canada and internationally, prior research has typically avoided taking a national or even multi-jurisdictional approach in measuring the extent of the issue. This study estimates use of three unnecessary services identified by CWC recommendations across multiple Canadian jurisdictions.MethodsTwo retrospective cohort studies were conducted using administrative health care data collected between fiscal years 2011/12 and 2012/13 to respectively quantify use of 1) diagnostic imaging (spinal X-ray, CT or MRI) among Albertan patients following a visit for lower back pain and 2) cardiac tests (electrocardiogram, chest X-ray, stress test, or transthoracic echocardiogram) prior to low-risk surgical procedures in Alberta, Saskatchewan, and Ontario. A cross-sectional study of the 2012 Canadian Community Health Survey was also conducted to estimate 3) the proportion of females aged 40–49 that reported having a routine mammogram in the past two years.ResultsUse of unnecessary care was relatively frequent across all three services and jurisdiction measured: 30.7% of Albertan patients had diagnostic imaging within six months of their initial visit for lower back pain; a cardiac test preceded 17.9 to 35.5% of low-risk surgical procedures across Alberta, Saskatchewan, and Ontario; and 22.2% of Canadian women aged 40–49 at average-risk for breast cancer reported having a routine screening mammogram in the past two years.ConclusionsThe use of potentially unnecessary care appears to be common in Canada. This investigation provides methodology to facilitate future measurement efforts that may incorporate additional jurisdictions and/or unnecessary services.
Highlights
Through the Choosing Wisely Canada (CWC) campaign, national medical specialty societies have released hundreds of recommendations against health care services that are unnecessary, i.e. present little to no benefit or cause avoidable harm
We focus on three CWC recommendations relevant to primary care that advise against the following potentially unnecessary tests: 1) imaging for lower back pain in the absence of red flags [15, 16]; 2) routine performance of preoperative testing for patients undergoing low-risk surgeries [17,18,19]; and 3) routine screening mammography for average-risk women aged 40–49 [16, 20]
Lower back pain imaging The resulting cohort consisted of 97,740 adult Albertans who made their first visit to a primary care physician for non-persistent lower back pain in 2011/2012
Summary
Through the Choosing Wisely Canada (CWC) campaign, national medical specialty societies have released hundreds of recommendations against health care services that are unnecessary, i.e. present little to no benefit or cause avoidable harm. This study estimates use of three unnecessary services identified by CWC recommendations across multiple Canadian jurisdictions. Based on a published framework for measuring unnecessary or “low-value” care, we aim to develop common methodological approaches to estimating overuse at a national level by utilizing existing, routinely collected administrative and survey data in Canada [14]. To facilitate measurement across multiple Canadian jurisdictions, the Choosing Wisely Canada (CWC) campaign partnered with the Canadian Institute for Health Information (CIHI) to provide large-scale estimates of unnecessary care across provinces and territories. By piloting a practical application of this measurement framework, we hope to develop standardized methods of measuring unnecessary care that might be applied across Canada and, in doing so, may serve as a model for how other countries approach quantifying unnecessary care at a national level [14]
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