Article type
Year
Abstract
Background: A substantial proportion of health care delivered globally is inappropriate as evidenced by harmful and/or ineffective practices being overused and effective practices being underused. This inappropriate healthcare leads to negative patient experiences, poor health outcomes, and inefficient use of scarce healthcare resources. The purpose of this study was to conduct a systematic review of inappropriate healthcare practices in Canada.
Objectives: 1) Systematically search and critically review published and grey literature on inappropriate healthcare practices in Canada. 2) Describe the nature and magnitude of inappropriate healthcare in Canada.
Methods: Multiple online databases and grey literature sources were searched to identify quantitative studies reporting objective or subjective measurements of inappropriate healthcare practices in Canada. Inclusion was limited to studies from January 2007 to September 2019 that reported on large or diverse populations. Two authors independently screened, assessed quality and extracted the data. Study findings were synthesized narratively by overuse and underuse in three care categorizations: tests, treatments, and procedures.
Results: A total of 138 studies were included. The majority of studies were conducted in the acute or specialty sector (n=74, 54%), followed by primary care (n=19, 14%). Other sectors represented less frequently included: long-term care, home and community, public health, and rehabilitation. While all Canadian regions were represented, most studies reported data from Ontario (n=85, 62%) or Alberta (n=46, 33%). Similar proportions of studies examined underuse (n=78, 56%) and overuse (n=72, 52%) of clinical practices. There was wide variation between studies in the magnitude of inappropriate care reported. Underuse of: tests ranged from 0.1% (computed tomography imaging for abdominal pain) to 100% (subjective global assessment tool for assessing malnutrition); treatments ranged 1.1% (anti-hyperglycemic medications for Diabetes) to 100% (probiotics before colorectal surgery); and procedures ranged 9.4% (endoscopy for colorectal cancer screening) to 98.1% (carotid endarterectomy/stenting for transient ischemic attack/stroke patients). Overuse of: tests ranged from 0.09% (carotid imaging) to 92.7% (breast cancer imaging); treatments ranged 0.06% (opioid use for dental pain) to 86.8% (polypharmacy (≥10 medications) among older adults); and procedures ranged 10.8% (angiography) to 22% (caesarean delivery).
Conclusions: Through this review, we addressed a critical gap in the literature by producing the first-ever evidence-based Canadian compendium of inappropriate health care practices. Our findings can be used to advance quality improvement programs, as well as support agencies dedicated to quality and patient safety, in Canada.
Patient or healthcare consumer involvement: Several stakeholders, including patients and representatives from quality improvement organizations, across Canada were centrally involved in designing and carrying out this systematic review.
Objectives: 1) Systematically search and critically review published and grey literature on inappropriate healthcare practices in Canada. 2) Describe the nature and magnitude of inappropriate healthcare in Canada.
Methods: Multiple online databases and grey literature sources were searched to identify quantitative studies reporting objective or subjective measurements of inappropriate healthcare practices in Canada. Inclusion was limited to studies from January 2007 to September 2019 that reported on large or diverse populations. Two authors independently screened, assessed quality and extracted the data. Study findings were synthesized narratively by overuse and underuse in three care categorizations: tests, treatments, and procedures.
Results: A total of 138 studies were included. The majority of studies were conducted in the acute or specialty sector (n=74, 54%), followed by primary care (n=19, 14%). Other sectors represented less frequently included: long-term care, home and community, public health, and rehabilitation. While all Canadian regions were represented, most studies reported data from Ontario (n=85, 62%) or Alberta (n=46, 33%). Similar proportions of studies examined underuse (n=78, 56%) and overuse (n=72, 52%) of clinical practices. There was wide variation between studies in the magnitude of inappropriate care reported. Underuse of: tests ranged from 0.1% (computed tomography imaging for abdominal pain) to 100% (subjective global assessment tool for assessing malnutrition); treatments ranged 1.1% (anti-hyperglycemic medications for Diabetes) to 100% (probiotics before colorectal surgery); and procedures ranged 9.4% (endoscopy for colorectal cancer screening) to 98.1% (carotid endarterectomy/stenting for transient ischemic attack/stroke patients). Overuse of: tests ranged from 0.09% (carotid imaging) to 92.7% (breast cancer imaging); treatments ranged 0.06% (opioid use for dental pain) to 86.8% (polypharmacy (≥10 medications) among older adults); and procedures ranged 10.8% (angiography) to 22% (caesarean delivery).
Conclusions: Through this review, we addressed a critical gap in the literature by producing the first-ever evidence-based Canadian compendium of inappropriate health care practices. Our findings can be used to advance quality improvement programs, as well as support agencies dedicated to quality and patient safety, in Canada.
Patient or healthcare consumer involvement: Several stakeholders, including patients and representatives from quality improvement organizations, across Canada were centrally involved in designing and carrying out this systematic review.