Clinical practices in Canada not being used properly

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Researchers have found that as many as 228 clinical practices in Canada are not being used properly and findings indicate that the practices such as blood tests and radiography are being underused.

Published in CMAJ (Canadian Medical Association Journal), the research can help health care professionals, organizations and governments improve patient care and health outcomes https://www.cmaj.ca/lookup/doi/10.1503/cmaj.211416.

Researchers found large gaps between the care that people should receive and the actual care that they are receiving. They found that on an average as many as 30 per cent of the people in Canada receive inappropriate care.

Researchers included 174 studies that evaluated whether clinical practices in Canada were meeting evidence-based guidelines. Together, these studies included 228 clinical practices and evaluated more than 28.9 million patients between 2007 and 2021. The researchers found inappropriate care in 30% of cases, with a median score of 44% for underuse and a median of 14% for overuse in diagnostics and therapeutics. Certain diagnostics were underused, such as glycated hemoglobin tests, lipid panel blood tests and diabetic eye exams. The most frequently overused diagnostics were the blood test for thyroid-stimulating hormone, chest radiographs and Pap tests.

Inappropriate care can lead to harm from the use or lack of use of a therapy or diagnostic procedure, contribute to negative patient experiences, and lead to poor health outcomes and inefficient use of scarce health care resources.

“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 authors write.

They suggest that provincial and territorial governments, as well as quality improvement organizations, can use these findings to improve health care quality and conduct additional research. Clinicians can reference the list of clinical practices, especially the top 42 most-studied practices, to identify priorities for change.