ArticleCMAJ open
Frequency of and variation in low-value care in primary care: a retrospective cohort study.
Article in CMAJ open. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 24 papers, 3 of them syntheses that pooled it.
What it found
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
24 citing papers in PubMed, 3 syntheses or guidelines pooled it, 29 citations in OpenAlex.
- Impact and effect of imaging referral guidelines on patients and radiology services: a systematic review.European radiology · 2025Pooled it
- Inappropriate use of clinical practices in Canada: a systematic review.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2022Pooled it
- Overuse of diagnostic testing in healthcare: a systematic review.BMJ quality & safety · 2022Pooled it
- Physician-suggested strategies for deimplementing low-value care in Swedish primary care: a qualitative analysis across system levels.Implementation science communications · 2026Article
- Gender Disparities in Adverse Events Resulting From Low-Value Practices in Family Practice in Spain: A Retrospective Cohort Study.International journal of public health · 2024Article
- Screening for primary prevention of fragility fractures: How much time does it take?Canadian family physician Medecin de famille canadien · 2023Article
- 'Give me something meaningful': GPs perspectives on how to improve an audit and feedback report provided by health insurers - an exploratory qualitative study.BMJ open quality · 2022Article
- Identifying drivers of health care value: a scoping review of the literature.BMC health services research · 2022Article
- Low-value pharmaceutical care among Dutch GPs: a retrospective cohort study.The British journal of general practice : the journal of the Royal College of General Practitioners · 2022Article
- Visualizing the Invisible: Invisible Waste in Diagnostic Imaging.Healthcare (Basel, Switzerland) · 2021Article
- What can we learn from the SARS-COV-2 pandemic about the value of specific radiological examinations?BMC health services research · 2021Article
- An Association Between Cardiologist Billing Patterns, Health Care Use, and Outcomes in Cardiac Patients.CJC open · 2021Article
- Association of Low-Value Testing With Subsequent Health Care Use and Clinical Outcomes Among Low-risk Primary Care Outpatients Undergoing an Annual Health Examination.JAMA internal medicine · 2020Observational
- Identifying and de-implementing low-value care in primary care: the GP's perspective-a cross-sectional survey.BMJ open · 2020Article
- Clinician-Level Variation in Three Measures Representing Overuse Based on the American Geriatrics Society Choosing Wisely Statement.Journal of general internal medicine · 2020Article
- Assessing volume and variation of low-value care practices in the Netherlands.European journal of public health · 2020Article
- Measuring the frequency and variation of unnecessary care across Canada.BMC health services research · 2019Article
- Frequency and Associations of Prescription Nonsteroidal Anti-inflammatory Drug Use Among Patients With a Musculoskeletal Disorder and Hypertension, Heart Failure, or Chronic Kidney Disease.JAMA internal medicine · 2018Article
- Physician Characteristics Associated With Ordering 4 Low-Value Screening Tests in Primary Care.JAMA network open · 2018Article
- Moving low value care lists into action: prioritizing candidate health technologies for reassessment using administrative data.BMC health services research · 2018Article
Corrections and comments
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Authors and funding
12 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundLow-value care, defined as care with a lack of benefit, can lead to higher health care costs, inconvenience to patients and, in some cases, harm to patients. The objectives of this study are to conduct exploratory analyses to understand how frequently selected low-value tests are ordered, to assess the degree of variation in ordering that exists across regions and practices, and to identify services that may warrant further investigation and targeted interventions.
methodsWe conducted a population-based retrospective cohort study using administrative health care databases from Ontario to identify rates of use of the following low-value services between fiscal years 2008/09 and 2012/13: computed tomography (CT) or magnetic resonance imaging (MRI) after a diagnosis of low back pain, Papanicolaou testing in women less than 21 years of age or older than 69 years of age and repeated dual-energy X-ray absorptiometry (DEXA) scanning within 2 years of an index scan. Regional and practice-level rates were calculated. Bivariate analyses were conducted to explore associations between patient factors and repeat DEXA scans.
resultsRepeated DEXA scans were the most common service (21.0%), whereas cervical cancer screening among women less than 21 years of age or older than 69 years of age (8.0%) and CT or MRI imaging for low back pain (4.5%) were less common. There was substantial variation across practices with rates of repeated DEXA scans, ranging from 4.0% to 54.9%, and cervical cancer screening, ranging from 0.9% to 35.2%. Patients with a high-risk index DEXA were more likely to receive a repeat scan (28.1%) than those with a baseline (8.9%) or low-risk (8.1%) scan.
interpretationThere is significant, practice-level variation in the frequency of low-value testing for DEXA scans, back imaging and cervical cancer screening. There is a particular need for interventions that aim to reduce unnecessary DEXA scans.
Identifiers
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.