Dialogue Volume 13 Issue 2 2017 - Page 39

choosing wisely Managing the Epidemic of Unnecessary Care Landmark report offers national data on test and treatment overuse By Stuart Foxman photo: istockphoto.com It’s one of the biggest areas of care in Canada, accounting for more than 1 million tests and treatments every year. Heart care? Cancer care? Emergency care? Mental health care? None of the above. The answer is unnecessary care, says a new study by Choosing Wisely Canada (CWC) and the Canadian Institute for Health Information (CIHI). Dr. Wendy Levinson, CWC Chair and Professor of Medicine, University of Toronto, calls it “care that doesn’t add value to patients or in some cases may be harmful.” Such interventions also waste health-care resources and increase wait times for people who truly need them. That detracts from higher priorities in the system, added David O’Toole, President and CEO of CIHI, at a webinar to kick off the report in April. The report, called “Unnecessary Care in Canada”, presents data on eight tests and treatments spanning the health system. It concludes that up to 30% are potentially needless. For instance, the report notes that: Almost 1 in 3 low-risk patients with minor head trauma in Ontario and Alberta nevertheless had a CT head scan in an emergency department. In Ontario, 35% of patients undergoing low-risk surgery had a preoperative test, such as a chest X-ray, ECG or cardiac stress test. 22% of Canadian women age 40-49 received a screening mammogram, despite being of average risk. 1 in 10 seniors in Canada use a benzodiazepine on a regular basis to treat insomnia, agitation or delirium, even though this isn’t recommended by experts. The downsides can be profound. Beyond squandering resources, there’s possible damage from various side effects and risks, patient anxiety and false positives. Just citing one example, Dr. Levinson noted that long-term sedative use can lead to forgetfulness and falls. From a clinical standpoint, “We harm more people than we help when we use these drugs.” Wide regional practice variations CWC is a clinician-led campaign. It partners with national specialty societies to develop evidence-based recommendations (over 200 to date) about unwarranted tests, treatments and procedures. “This is the first time we have Canada-wide data of some Issue 2, 2017 Dialogue 39