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(L-R) Cherry Chu and Zack Bouck

Ending Low-Value Care

Choosing healthcare services wisely

When it comes to healthcare, more is not always better. In fact, research shows that in Canada up to 30 per cent of tests, treatments and procedures are potentially unnecessary. 

Choosing Wisely Canada is a national effort dedicated to taking action against low-value healthcare. Working with clinicians, patients, researchers and other healthcare professionals, Choosing Wisely engages Canadians and helps our health system re-think the appropriateness of healthcare services. The Women’s College Hospital Institute for Health System Solutions and Virtual Care (WIHV) is the lead evaluator of Choosing Wisely Canada, providing research insights that drive new recommendations. 

Low-value healthcare is not only a waste of healthcare resources, it also has the potential to negatively affect a patient’s healthcare experience, including the emotional stress of waiting for test results and the physical harm of having to undergo invasive procedures. 

“In a recent study, we found that a small group of ‘frequent users’ comprised of only 18.4 per cent of primary care physicians in Ontario, ordered over 32 per cent of low-value screening tests,” said Dr. Sacha Bhatia, WIHV’s director and the measurement and evaluation lead of Choosing Wisely Canada. 

Dr. Sacha Bhatia

“The doctors included in this ‘frequent users’ group were more likely to be male, further removed from medical school and enrolled in a fee-for-service payment model,” Bhatia added. Understanding the profile of who is ordering too many tests is the first step in crafting a targeted strategy to partner with physicians and reduce over-testing.

Low-Value Care in Canada

  • One in 10 seniors in Canada uses a benzodiazepine (sedative-hypnotic drug) regularly, increasing their risks for falls, hip fractures, motor vehicle accidents and daytime fatigue
  • In Ontario, Saskatchewan and Alberta, 18 per cent to 35 per cent of patients having a low-risk procedure had a preoperative test. Doing preoperative tests before a low-risk surgery does little to improve care, wastes resources and can distress patients.
  • 30 per cent of emergency department patients in Ontario and Alberta with a low-risk minor head trauma receive a CT scan. Doing a CT scan in these cases doesn’t improve patient outcomes, exposes patients to radiation and increases wait times for other patients.

WIHV’s findings are spreading and already having impact on how healthcare is delivered. Not only has our Choosing Wisely research been mentioned in the media and taken up by health teams across the country, but it has also been taken up by physician-led organizations like the Ontario Medical Association (OMA). In fact, the Institute’s research findings were cited as a reason for the recently created appropriateness working group led by the OMA and the provincial Ministry of Health. The working group will further assess low-value care services and their financial impact on the health system in Ontario. 

“Choosing Wisely Canada is proud to collaborate with WCH Institute for Health System Solutions and Virtual Care (WIHV). WIHV has been instrumental in leading measurement and evaluation efforts that help us better understand the complex problem of overuse in healthcare. These efforts help drive meaningful and sustained change that improve patient and health system outcomes.” – Dr. Wendy Levinson, Chair, Choosing Wisely Canada

Working with the University of Ottawa and other partners, WIHV has recently started testing out new ways to reduce low-value care in Canada through a Canadian Institutes of Health Research (CIHR) grant. Going forward, WIHV will be investigating the downstream effects of low-value care, particularly how it affects healthcare utilization and patient outcomes. The team is expanding their research focus to other areas including prescription drugs.