Up to 30 Per Cent of Medical Care Canadians Receive is Unnecessary: Report
Republished from the Globe and Mail
Canadians undergo more than a million medical tests and treatments every year that they may not need, according to a new report that reveals big variations in the ordering of some procedures.
The study puts a spotlight on unnecessary medical care that ranges from MRI scans for run-of-the-mill back pain to preoperative tests for low-risk colonoscopy patients and the over-prescribing of some drugs for seniors and children.
Published Thursday by the Canadian Institute for Health Information, the report is part of a national effort to cut waste in the health-care system and prevent the harm to patients that can sometimes flow from superfluous care.
Read also: Most Canadians get timely medical treatment, but not all have equal access: report
Wendy Levinson, a professor of medicine at the University of Toronto, launched the Canadian incarnation of the campaign in 2014. Dubbed Choosing Wisely, it was modelled on a program that aimed to reduce unnecessary care in the United States, where a 2012 report from the influential Institute of Medicine (IOM) found the health-care system squandered about $750-billion a year, much of it on procedures patients did not need.
“I thought at the beginning, when we started Choosing Wisely [Canada], that we would not have the same degree of unnecessary care in Canada because we don’t have the same motivators as the U.S.,” Dr. Levinson said. “I think [this report] tells us this is an issue in Canada.”
But unlike the IOM report, the Canadian study avoids talking about dollars and cents.
Clinicians can become “jaded and cynical” if a program smacks of rationing, said Donna McRitchie, a surgeon and the vice-president of medical and academic affairs at North York General Hospital in Toronto, one of the first hospitals to embrace the Choosing Wisely approach. “People just sort of roll their eyes and say: ‘Oh, it’s just administration trying to save money,’ ” Dr. McRitchie said. “So we purposely don’t really talk about money.”
Instead, the Canadian report looks at how parts of the country are faring on eight of the more than 200 recommendations for curbing waste in medical care that Choosing Wisely has developed in co-operation with doctors and patients. Many of the statistics date from before the debut of the campaign and will be used as a baseline against which to measure its success.
One of the campaign’s recommendations is that imaging for lower back pain not be ordered unless there are red flags such as suspected cancer or infection. The study, which this case looked only at Alberta data from 2011-2012, found that 30 per cent of patients with back aches underwent at least one X-ray, MRI or CT scan they probably did not need.
Last summer, Alberta introduced a new lumbar spine screening form and educated health-care providers about when to skip scans for uncomplicated back pain, which usually heals on its own in four to six weeks.
“The early results are showing a decrease [in scans] of about 15 to 17 per cent,” said William Hnydyk, the lead physician for implementing the Choosing Wisely recommendations in Alberta.
That decrease does not necessarily save money, Dr. Hnydyk said, but it does free up MRI, CT and X-ray slots for patients who really need them, which should reduce waiting times.
Dr. Levinson said unnecessary care creeps into the health-care system for a slew of reasons.
Part of the problem is patients, armed with medical advice from the Internet, demanding cutting-edge tests and treatments. Part of it is doctors ordering procedures to appease those patients or to protect themselves from lawsuits if something goes wrong.
But the biggest contributor, Dr. Levinson said, is the way excessive care is “baked into” the health-care system, with hospitals relying on outdated forms that make tests automatic and doctors ordering procedures out of habit when the latest evidence shows they don’t have much benefit.
North York General Hospital tackled that problem by reviewing more than 800 “order sets,” which stipulate what doctors and nurses should do when patients turn up at the hospital with different illnesses.
“Instead of having blood work every day for five days, we changed [some] to every day for two days or three days,” Dr. McRitchie said. “We took out some of the daily chest X-rays, and we took out some of the routine urinalysis tests. We took out things that we knew we didn’t really need.”
After implementing the program, the hospital saw a 31-per-cent decline in the number of tests ordered in its emergency department. The savings from 10 common lab tests totalled $157,000 in one year, money that was redirected to medical care patients actually needed.