Canadians have more than 1 million potentially unnecessary medical tests and treatments every year

Looking at selected medical tests, treatments and procedures in Canada, a new report finds that up to 30 per cent 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.

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:

1. 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.
2. 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.
3. In Ontario, Saskatchewan and Alberta, 18 to 35 per cent 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.
4. 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.

“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 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.”

“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.”