Investigating Unneeded Care in Canada

On April 6, Choosing Wisely Canada and the Canadian Institute for Health Information released “Unnecessary Care in Canada”, a new report that measured the amount of unnecessary care associated with eight tests and procedures identified in Choosing Wisely Canada recommendations. The report found that 30 percent of selected medical tests, treatments and procedures in Canada are potentially unwarranted – leading to more than 1 million unneeded tests and treatments every year.

The report also shared success stories from organizations and individual clinicians across the country working to reduce unnecessary care:

• In 2014, Vancouver Coastal Health and Providence Health Care tackled physician practice variation for five medical imaging procedures, including for lower-back pain, using a multipronged strategy. Following the intervention, physician variation in the ordering of imaging was significantly reduced for lower-back pain (interquartile range from 17 to 11 percent).
• North York General Hospital has decreased lab tests by 38 percent in its preoperative clinic since February 2015 by introducing Choosing Wisely Canada recommendations into order sets.
• Capital Health in Halifax, Nova Scotia, rolled out a new policy “to transfuse one red cell unit and then reassess based on hemoglobin level/clinical symptoms.” Since 2012, the overall number of red cells units transfused has decreased by 16.4 percent.

The eight tests and treatments studied included:

• Imaging for minor head trauma unless red flags are present
• Screening mammography for average-risk women age 40 to 49
• Imaging for lower-back pain unless red flags are present
• Transfusing red blood cells for arbitrary hemoglobin or hematocrit thresholds
• Preoperative testing before low-risk surgeries
• Head CT scans in hospitalized patients with delirium in the absence of risk factors
• Benzodiazepines and/or other sedative-hypnotics in older adults as a first choice for insomnia, agitation or delirium
• Atypical antipsychotics as a first-line intervention for insomnia in children and youth

Read the full report to learn more.