Canadian patients are receiving fewer low-value medical interventions, but there’s still room for improvement

Canada’s health care systems are experiencing unprecedented pressure, and reducing the overuse of low-value tests, treatments and procedures could help ease the strain. A new report from the Canadian Institute for Health Information (CIHI) and Choosing Wisely Canada (CWC) shows that progress has been made in reducing low-value tests, treatments and procedures but there is still opportunity for further reductions.

The report looks at 12 recommendations made by CWC in collaboration with Canadian clinician societies regarding care that offers little to no benefit to patients and may even cause harm. Over a 5-year period, the overuse of 8 out of the 12 tests and treatments examined decreased by 10% or more in provinces where data was reported. Specifically, there was a cumulative reduction of about 826,000 tests, treatments and procedures that would not have benefited patients:

• 698,000 fewer unnecessary prescriptions and other treatments 
• 115,000 fewer low-value X-rays, CT scans, MRIs and preoperative tests 
• 13,000 fewer unnecessary surgical procedures

Many of these reductions could result in better care for Canadian seniors. For example, the report found that the rate of knee arthroscopies for adults age 60 and older decreased by almost half compared with 5 years ago. For this age group, exercise therapy, medication and injections have been found to be just as effective in treating knee issues. As well, the rate of daily physical restraint use in long-term care homes declined from 8.6% of residents in 2014–2015 to 4.6% in 2019–2020. This is equivalent to 18,000 fewer residents in daily physical restraints in 2019–2020 compared with 2014–2015.

The report also shows that the rates of overuse for the 12 tests, treatments and procedures vary across the provinces and territories. If all jurisdictions could achieve the rates of the lowest province for each recommendation, it is estimated that an additional 1.9 million tests, treatments and procedures could be avoided each year.

“Overuse remains a long-standing problem that strains our already overstretched health care systems,” says Dr. Wendy Levinson, Chair of Choosing Wisely Canada. “The findings in this report are encouraging that Canada has made progress in reducing low-value care through collaborative efforts with clinicians, patients, administrators, researchers and policy-makers.” 

“It is encouraging to see some decline in the rates of overuse across the country,” says Tracy Johnson, Director of Health System Analytics at CIHI. “Health systems are responding to the recommendations regarding more appropriate use of scarce health care resources, and Choosing Wisely will be more important than ever as health care providers grapple with the backlog of care following closures during the pandemic.”