ArticleBMC health services research2019
Measuring the frequency and variation of unnecessary care across Canada.
Article in BMC health services research, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 21 papers, 3 of them syntheses that pooled it.
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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
21 citing papers in PubMed, 3 syntheses or guidelines pooled it, 50 citations in OpenAlex.
- 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
- The effectiveness of behavioral economics-informed interventions on physician behavioral change: A systematic literature review.PloS one · 2020Pooled it
- "Diagnostic pathways in femoroacetabular impingement, patterns of clinical visits, and MRI utilization before hip arthroscopy in Türkiye".Scientific reports · 2025Article
- To treat or not to treat? Oncologists' perceptions and experiences regarding overtreatment in end stage cancer patients.Frontiers in medicine · 2025Article
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- Effects of chiropractic use on medical healthcare utilization and costs in adults with back pain in Ontario, Canada from 2003 to 2018: a population-based cohort study.BMC health services research · 2023Article
- Innovating for Value-Based Surgical Care in Canada: A Post-Pandemic Necessity.Healthcare policy = Politiques de sante · 2023Article
- Randomized controlled trials in de-implementation research: a systematic scoping review.Implementation science : IS · 2022Article
- Adherence to spinal imaging guidelines and utilization of lumbar spine diagnostic imaging for low back pain at a Canadian Chiropractic College: a historical clinical cohort study.Chiropractic & manual therapies · 2022Article
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- 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
- Characterizing and quantifying low-value diagnostic imaging internationally: a scoping review.BMC medical imaging · 2022Article
- Article
- Which symptoms are the psychopathological core affecting the manifestation of pseudo-cardiac symptoms and poor sleep quality in young adults? Symptoms of personality disorders versus clinical disorders.Frontiers in psychology · 2022Article
- An Association Between Cardiologist Billing Patterns, Health Care Use, and Outcomes in Cardiac Patients.CJC open · 2021Article
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- Development of a Soft Tissue Knee Clinical Decision-Making Tool for Patients Presenting to Primary Point-of-Care Providers in Alberta, Canada.Journal of primary care & community healthArticle
- Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
11 authors at 5 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThrough the Choosing Wisely Canada (CWC) campaign, national medical specialty societies have released hundreds of recommendations against health care services that are unnecessary, i.e. present little to no benefit or cause avoidable harm. Despite growing interest in unnecessary care both within Canada and internationally, prior research has typically avoided taking a national or even multi-jurisdictional approach in measuring the extent of the issue. This study estimates use of three unnecessary services identified by CWC recommendations across multiple Canadian jurisdictions.
methodsTwo retrospective cohort studies were conducted using administrative health care data collected between fiscal years 2011/12 and 2012/13 to respectively quantify use of 1) diagnostic imaging (spinal X-ray, CT or MRI) among Albertan patients following a visit for lower back pain and 2) cardiac tests (electrocardiogram, chest X-ray, stress test, or transthoracic echocardiogram) prior to low-risk surgical procedures in Alberta, Saskatchewan, and Ontario. A cross-sectional study of the 2012 Canadian Community Health Survey was also conducted to estimate 3) the proportion of females aged 40-49 that reported having a routine mammogram in the past two years.
resultsUse of unnecessary care was relatively frequent across all three services and jurisdiction measured: 30.7% of Albertan patients had diagnostic imaging within six months of their initial visit for lower back pain; a cardiac test preceded 17.9 to 35.5% of low-risk surgical procedures across Alberta, Saskatchewan, and Ontario; and 22.2% of Canadian women aged 40-49 at average-risk for breast cancer reported having a routine screening mammogram in the past two years.
conclusionsThe use of potentially unnecessary care appears to be common in Canada. This investigation provides methodology to facilitate future measurement efforts that may incorporate additional jurisdictions and/or unnecessary services.
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Registered trials
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