COVID-19 can be an opportunity to eliminate low-value health care

The COVID-19 pandemic has stretched health care systems across Canada beyond capacity. Surges of COVID-19 have strained available beds, exhausted health care workers and resources. To cope with these surges, some regional and provincial health systems delayed all non-essential procedures, tests and surgeries.

Canadians’ health-seeking behaviours have changed over the past year with steep drops in utilization of emergency and hospital care.

We know that some of these delays in care may have resulted in harm. But we also know that some of these delayed health care procedures and visits did not result in any harm. What can we learn from the pandemic about unnecessary tests and treatments?

Research shows us that that over 30 per cent of all health care offered prior to the pandemic lacked clinical value to patients. As health care 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 health care systems are under significant pressure to do more with less. Addressing the backlog of delayed care can be done equitably by using resources wisely.

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.

Karen Born, PHD. | Photo courtesy of QUOI Media Group

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 to access 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 expert panel emphasized recommendations about 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 unnecessary pre-operative tests can sometimes harm patients by delaying surgeries further, but they also increase wait times for those who truly need these imaging tests and procedures.

Dr. Ken Milne. | Photo courtesy of QUOI Media Group

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 do 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, and a conversation with patients, can help inform the diagnosis of osteoarthritis and a treatment plan.

The pandemic has made all of us more aware of Canada’s health care 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 “do I really need this test or treatment?” Whether it be from concerns of COVID-19 or understanding how stretched our resources are, we have never been more aware of how we interact with the health care system.

This is a pivotal moment as we think about the road to recovery. Avoiding reintroduction of low-value care will be integral as providers and health care systems catch up to provide services and care to those who need it most.

It starts with a conversation between health care providers and patients, one at a time. And here’s how to get it started. Ask: (1) Do I really need this test, treatment or procedure? (2) What are the downsides? (3) Are there simpler, safer options? (4) 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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