Up to 30% of tests may be unnecessary: study

OTTAWA – Looking at selected medical tests, treatments and procedures in Canada, a new report finds that up to 30 percent of them are potentially unnecessary. Unnecessary tests and treatments waste health system resources, increase wait times for patients in need and can lead to patient harm.

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 eight tests and procedures that span the health system.

Choosing Wisely Canada is a national, clinician-led campaign that partners with national clinician specialty societies to develop evidence-based recommendations about tests, treatments and procedures that are unnecessary and offer no value to patients. To date, Choosing Wisely Canada has released more than 200 recommendations.

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

This report also details success stories – from national- and facility-level organizations as well as from individual clinicians across the country – of using the recommendations to identify and reduce unnecessary care.

Highlights from the report include the following:

• Almost 1 in 3 low-risk patients with minor head trauma in Ontario and Alberta had a head scan in an emergency department, despite a Choosing Wisely Canada recommendation that this is unnecessary and potentially harmful.
• 1 in 10 seniors in Canada use a benzodiazepine on a regular basis to treat insomnia, agitation or delirium. A number of Choosing Wisely Canada recommendations highlight the harms of long-term use of these medications.
• In Ontario, Saskatchewan and Alberta, 18% to 35% of patients undergoing low-risk surgery had a preoperative test, such as a chest X-ray, ECG or cardiac stress test. Choosing Wisely Canada recommendations highlight that these tests are unnecessary, are potentially harmful and can delay surgery.
• For children and youth in Manitoba, Saskatchewan and British Columbia, the rates of low-dose quetiapine (likely used to treat insomnia) increased rapidly to 186 per 100,000 in 2013-2014 from 104 in 2008-2009. Choosing Wisely Canada recommends against the use of this medication in children and youth to treat insomnia.

Regional- and facility-level variations also signal that unnecessary care may be taking place and suggest that there is room for improvement.

“Many Canadians experience care that may be unnecessary,” said David O’Toole, president and CEO, CIHI. “This report is another step toward ongoing standardization of measures and improved data to identify gaps, track improvements and ultimately improve the quality of – and access to – care for Canadians.”

About CIHI

The Canadian Institute for Health Information (CIHI) is an independent, not-for-profit organization that provides essential information on Canada’s health systems and the health of Canadians. We provide comparable and actionable data and information that are used to accelerate improvements in healthcare, health system performance and population health across Canada. Our stakeholders use our broad range of health system databases, measurements and standards, together with our evidence-based reports and analyses, in their decision-making processes. We protect the privacy of Canadians by ensuring the confidentiality and integrity of the healthcare information we provide.

About Choosing Wisely Canada

Choosing Wisely Canada is a campaign to help clinicians and patients engage in conversations about unnecessary tests and treatments, and make smart choices. Choosing Wisely Canada is led by Canada’s healthcare professionals, with more than 50 national colleges, societies and associations participating as partners of the campaign.