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opinion: pandemic highlights low value care
research shows that over 30 per cent of all healthcare offered prior to the pandemic lacked clinical value to patients.
avoiding the reintroduction of low value care will be integral as providers and healthcare systems catch up to provide services.
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the covid-19 pandemic has stretched health care systems across canada beyond capacity. surges of covid-19 have strained available beds and exhausted both healthcare workers and resources. to cope with these surges, some regional and provincial health systems have delayed all non-essential procedures, tests and surgeries.
at the same time, canadians’ health-seeking behaviours have changed over the past year with steep drops in utilization of emergency and hospital care. and while we know some of these delays in care may have resulted in harm, we also know that some didn’t.
unnecessary tests and treatments
research shows that over 30 per cent of all healthcare offered prior to the pandemic lacked clinical value to patients. as healthcare systems rebuild and reopen to the full range of pre-pandemic services, it is vital that this low value care be minimized to ensure capacity, services and care for those who need it most.
post-pandemic healthcare systems are under significant pressure to do more with less. addressing the backlog of delayed care can be done equitably by using resources wisely.
dr. karen born (left), is an assistant professor, institute of health policy, management & evaluation, dalla lana school of public health, university of toronto and knowledge translation lead, choosing wisely canada. dr. ken milne is an adjunct professor in the department of medicine (division of emergency medicine) and department of family medicine at the schulich school of medicine and dentistry. supplied
thankfully, there’s a large body of research to guide us. as part of a national process convened by the canadian agency for drugs and technology in health this spring which brought together an expert panel of patients, clinicians and decision makers, we reviewed over 400 clinician-led recommendations developed by national clinician societies to highlight opportunities to ensure high value care after the pandemic.
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here’s one example. one of us works as an emergency physician in a rural community in southwestern ontario and the problem of low value health care is a daily concern. the pandemic has heightened some of the already existing challenges rural areas face as patients often need to drive to larger centres to access specialized care and laboratory and imaging resources.
the evidence shows us that often these long drives, waits for tests and use of precious imaging resources are not necessary. the panel emphasized recommendations for avoiding sending patients from rural areas to urban centres to access care or services that could be delivered virtually and limiting blood and imaging tests, unless they are required to answer a specific clinical question or guide treatment.
we also know that while unnecessary pre-operative tests can sometimes harm patients by delaying surgeries further, they also increase wait times for those who truly need these imaging tests and procedures.
a common case seen in rural emergency departments are patients who are farmers or labourers with chronic knee pain who come in requesting an mri. rather than add their names to a long wait list and make a lengthy drive to the city for the test, an x-ray can be done locally — an mri is unlikely to change any decision making or treatment plan. rather than sending patients for unnecessary tests, a thorough physical exam and history, as well as a conversation with patients, can help inform the diagnosis of osteoarthritis and a treatment plan.
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the pandemic has made all of us more aware of canada’s healthcare system — including its strengths and its flaws. but we are seeing a turning point in the conversation in which patients, family members and the public are asking whether they do, in fact, need a test or treatment. whether it be because of concerns around covid-19 or understanding how stretched our resources are, we have never been more aware of how we interact with the healthcare system.
this is a pivotal moment as we think about the road to recovery. avoiding the reintroduction of low value care will be integral as providers and healthcare systems catch up to provide services and care to those who need it most.
it starts with a conversation between healthcare providers and patients in which we ask some critical questions: “do i really need this test, treatment or procedure?” “what are the downsides?” “are there simpler, safer options?” and “what happens if i do nothing?”
dr. karen born is an assistant professor, institute of health policy, management & evaluation, dalla lana school of public health, university of toronto and knowledge translation lead, choosing wisely canada.
dr. ken milne is an adjunct professor in the department of medicine (division of emergency medicine) and department of family medicine at the schulich school of medicine and dentistry . he has worked as a rural physician for 24 years.
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