Unnecessary care is care that isn’t helpful to diagnosis or treatment, isn’t supported by science and most importantly has no corresponding value to patients. In fact, it takes away from care by wasting health system resources, increasing wait times for patients in need and potentially exposing patients to harm.
Choosing Wisely Canada (CWC) is a campaign to help clinicians and patients engage in conversations about unnecessary tests and treatments and make smart and effective choices to ensure high-quality care. In a recent collaborative report with CWC, CIHI uses data to measure the extent of potentially unnecessary tests and procedures for 8 (out of 200+) CWC campaign recommendations that span different areas of the health care system: primary care, specialist care, emergency department care and hospital care. The data in this report illustrates the extent of unnecessary care in Canada and the many complex drivers of this problem.
How many Canadians are affected by unnecessary care?
We found that up to 30% of patients had potentially unnecessary tests, treatments and procedures associated with the 8 selected CWC recommendations. This translates into more than 1 million potentially unnecessary tests, treatments and procedures in Canada every year.
Noticeable regional and facility variation was found for each of the 8 recommendations, which suggests that there is room for improvement and that we can learn from others.
One of the recommendations looks at the overuse of benzodiazepines and other sedative–hypnotics among seniors in Canada. The data suggests that 1 in 10 patients age 65 and older use these sedatives on a regular basis to treat insomnia, agitation or delirium, although a number of CWC recommendations highlight the harms of long-term use of these medications. The concern is that older adults who use benzodiazepines or other sedative–hypnotics are at an increased risk for motor vehicle accidents, falls and hip fractures, and daytime fatigue.
Avoiding unnecessary care
Canadians are aware of the problem of unnecessary care, and are seeking more support and tools in order to make better decisions and to have informed conversations with health care providers.
About 1 in 4 Canadians were recommended by a doctor to undergo a test or treatment that they did not feel was necessary for their health. Patient expectations and preferences help to influence care practices, and patients and clinicians engaging in conversations is critical to improving standard treatment processes and can reduce unnecessary care.
Asking simple questions
To help foster better conversations around health care, the CWC campaign encourages both patients and clinicians to ask themselves the following 4 questions:
- Do I (does my patient) really need this test, treatment or procedure?
- What are the downsides?
- Are there simpler, safer options?
- What happens if I do (my patient does) nothing?
Asking these simple questions and having conversations can help to reduce unnecessary care and associated harm for Canadian patients.
If you want to know more, see A National Discussion: Unnecessary Care in Canada, where speakers share their success stories about unnecessary care.