Unnecessary Care in Canada

Gapanenko, Katerina; Lam, David M.; Parker, Michelle; D'Silva, Jennifer; Johnson, Tracy

doi:10.12927/hcq.2017.25295

Cited by 9 publications

(7 citation statements)

References 16 publications

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“…Inappropriate or low-value care includes both underuse and overuse of health services,8 representing 25% of care at an annual cost of US$100 billion in the USA alone 9. In Canada, 30% of primary and specialist care is unnecessary, with routine bloodwork identified as a considerable source of low-value care 10 11…”

Section: Introductionmentioning

confidence: 99%

Patient, hospital and environmental costs of unnecessary bloodwork: capturing the triple bottom line of inappropriate care in general surgery patients

et al. 2023

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ObjectiveTo characterise the extent of unnecessary care in general surgery inpatients using a triple bottom line approach.DesignPatients with uncomplicated acute surgical conditions were retrospectively evaluated for unnecessary bloodwork according to the triple bottom line, quantifying the impacts on patients, healthcare costs and greenhouse gas emissions. The carbon footprint of common laboratory investigations was estimated using PAS2050 methodology, including emissions generated from the production, transport, processing and disposal of consumable goods and reagents.SettingSingle-centre tertiary care hospital.ParticipantsPatients admitted with acute uncomplicated appendicitis, cholecystitis, choledocholithiasis, gallstone pancreatitis and adhesive small bowel obstruction were included in the study. 304 patients met inclusion criteria and 83 were randomly selected for in-depth chart review.Main outcome measuresIn each patient population, the extent of over-investigation was determined by comparing ordered laboratory investigations against previously developed consensus recommendations. The quantity of unnecessary bloodwork was measured by number of phlebotomies, tests and blood volume in addition to healthcare costs and greenhouse gas emissions.Results76% (63/83) of evaluated patients underwent unnecessary bloodwork resulting in a mean of 1.84 phlebotomies, 4.4 blood vials, 16.5 tests and 18 mL of blood loss per patient. The hospital and environmental cost of these unnecessary activities was $C5235 and 61 kg CO2e (974 g CO2e per person), respectively. The carbon footprint of a common set of investigations (complete blood count, differential, creatinine, urea, sodium, potassium) was 332 g CO2e. Adding a liver panel (liver enzymes, bilirubin, albumin, international normalised ratio/partial thromboplastin time) resulted in an additional 462 g CO2e.ConclusionsWe found considerable overuse of laboratory investigations among general surgery patients admitted with uncomplicated acute surgical conditions resulting in unnecessary burden to patients, hospitals and the environment. This study identifies an opportunity for resource stewardship and exemplifies a comprehensive approach to quality improvement.

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Section: Introductionmentioning

confidence: 99%

Patient, hospital and environmental costs of unnecessary bloodwork: capturing the triple bottom line of inappropriate care in general surgery patients

et al. 2023

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“…From 2001, the costs have increased by 116.4 percent [5]. A recent report also found up to 30% of selected medical tests, treatments and procedures in Canada are potentially unnecessary and that Canadians have more than one million potentially unnecessary medical tests and treatments every year [6]. This pandemic of low-value care affects the sustainability of publicly funded healthcare systems globally, requiring patients, healthcare providers and policymakers to cooperate in finding socially and politically acceptable solutions [7][8][9].…”

Section: Introductionmentioning

confidence: 99%

The role of patients in the governance of a sustainable healthcare system: A scoping review

et al. 2022

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Patients, healthcare providers and insurers need a governance framework to establish the ‘rules of use’ to deliver more responsible use of services. The objective of this review was to provide an overview of frameworks and analyze the definitions of patient accountability to identify themes and potential gaps in the literature. Fifteen bibliographic databases were searched until July 2021. This included: MEDLINE, EMBASE, CINAHL, PsycINFO, SPORTDiscus, Allied and Complementary Medicine Database, Web of Science, HealthSTAR, Scopus, ABI/INFORM Global, Cochrane Library, ERIC, International Bibliography of the Social Sciences, Sociological Abstracts, Worldwide Political Science Abstracts and International Political Science Abstracts. Searches were also completed in Google Scholar. Inclusion criteria included articles focused on accountability of patients, and exclusions included articles that were not available, not written in English, with missing information, and commentaries or editorials. In total, 85530 unique abstracts were identified, and 27 articles were included based on the inclusion criteria. The results showed that patient accountability is rarely used and poorly defined. Most studies focused on what patients should be held to account for and agreed that patients should be responsible for behaviours that may contribute to adverse health outcomes. Some studies promoted a punitive approach as a mechanism of enforcement. Most studies argued for positive incentives or written agreements and contracts. While many studies recognized the value of patient accountability frameworks, there was a concern that these frameworks could further exacerbate existing socioeconomic disparities and contribute to poor health-related behaviours and outcomes (e.g., stigmatizing marginalized groups). Shared models of accountability between patients and healthcare providers or patients and communities were preferred. Before committing to a patient accountability framework for improving patient health and sustaining a healthcare system, the concept must be acceptable and reasonable to patients, providers, and society as a whole.

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“…1 Similarly, in Canada, approximately 30% of tests, treatments, and procedures are considered to be potentially unnecessary, meaning that they do not add value for patients and further could be harmful. 2 The Choosing Wisely (CW) campaign was initiated by the American Board of Internal Medicine Foundation in 2012 to promote discussions between health care providers and patients about evidence-based and nonduplicative care, with the eventual aim of reducing low-value procedures and treatments. 3,4 CW has since expanded to 20 countries spanning five continents.…”

Section: Introductionmentioning

confidence: 99%

Implementation and Impact of Choosing Wisely Recommendations in Oncology

Nagarajah

Powis

Fazelzad

et al. 2022

JCO Oncology Practice

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The Choosing Wisely (CW) campaign, launched in 2012, includes oncology-specific recommendations to promote evidence-based care and deimplementation of low-value practices. However, it is unclear to what extent the campaign has prompted practice change. We systematically reviewed the literature to evaluate the uptake of cancer-specific CW recommendations focusing on the period before the declaration of the COVID-19 pandemic. We used Grimshaw's deimplementation framework to thematically group the findings and extracted information on implementation strategies, barriers, and facilitators from articles reporting on active implementation. In the 98 articles addressing 32 unique recommendations, most reported on passive changes in adherence pre-post publication of CW recommendations. Use of active surveillance for low-risk prostate cancer and reduction in staging imaging for early breast cancer were the most commonly evaluated recommendations. Most articles assessing passive changes in adherence pre-post CW publication reported improvement. All articles evaluating active implementation (10 of 98) reported improved compliance (range: 3%-73% improvement). Most common implementation strategies included provider education and/or stakeholder engagement. Preconceived views and reluctance to adopt new practices were common barriers; common facilitators included the use of technology and provider education to increase provider buy-in. Given the limited uptake of oncology-specific CW recommendations thus far, more attention toward supporting active implementation is needed. Effective adoption of CW likely requires a multipronged approach that includes building stakeholder buy-in through engagement and education, using technology-enabled forced functions to facilitate change along with policy and reimbursement models that disincentivize low-value care. Professional societies have a role to play in supporting this next phase of CW.

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Unnecessary Care in Canada

Cited by 9 publications

References 16 publications

Patient, hospital and environmental costs of unnecessary bloodwork: capturing the triple bottom line of inappropriate care in general surgery patients

Patient, hospital and environmental costs of unnecessary bloodwork: capturing the triple bottom line of inappropriate care in general surgery patients

The role of patients in the governance of a sustainable healthcare system: A scoping review

Implementation and Impact of Choosing Wisely Recommendations in Oncology

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