almost one-third of canadian clinical care ‘deemed inappropriate’
not enough use of blood tests and radiology leads to negative patient experiences, poor health outcomes and an inefficient use of resources, the researchers found.
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researchers found that inappropriate treatment led to poor health outcomes and an inefficient use of resources. getty
a new study has found that 30 per cent of clinical practices in canada are used inappropriately and frequently fall short of recommended standards.
the review, which was published in the canadian medical association journal, said that underuse was more common than overuse among these procedures, which include diagnostic and therapeutic practices such as blood tests and radiology. the use — or lack of use — of these procedures can result in inappropriate treatment that leads to negative patient experiences, poor health outcomes and an inefficient use of resources.
“the dominant finding from our review is that there are large gaps between the care people should receive and the care they do receive,” wrote janet squires, lead author professor of nursing at the university of ottawa, and her team of coauthors. “we found that, on average, 30 per cent of the care received by people in canada as assessed in the included research papers using the institute of medicine’s definitions of underuse and overuse, was deemed inappropriate.”
the team analyzed 174 studies that attempted to discern whether clinical practices in canada were adhering to evidence-based guidelines. these studies encompassed a combined 228 clinical practices and more than 28.9 million patients between 2007 and 2021. in the 30 per cent of incidents that resulted inappropriate care, researchers calculated a median score of 44 per cent for underuse and a median of 14 per cent for overuse in diagnostics and therapeutics. the practices most commonly underused included glycated hemoglobin tests, lipid panel blood tests and diabetic eye exams. the most overused included pap tests, chest radiographs and the blood test for thyroid-stimulating hormone.
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‘many clinical practices inappropriate’
“we found that many clinical practices received by people in canada are inappropriate; whether that practice is diagnostic or therapeutic, it frequently does not meet recommended standards,” the team said.
researchers hope that provincial and territorial governments, as well as quality improvement organizations, will use their findings — which include the 42 most-studied practices — to initiate their own research into inefficiencies and prioritize changes that will improve quality of care.
in a commentary that accompanies the article, kaveh shojania, a general internist at sunnybrook health sciences centre, argues that realigning priorities based social factors that have an outsized impact on health — such as housing, education, air and water quality and early childhood development — would maximize results, particularly in the face of the combined crises of the opioid crisis and the covid-19 pandemic.
“interventions addressing these factors would likely offer larger returns on investment than generating small increases in the uptake of recommended practices that mostly have small absolute impacts on health,” he wrote.
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dave yasvinski is a writer with healthing.ca
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