Can behavioural science help reduce unnecessary medical tests?
Up to one in three medical tests and treatments in Canada are not needed, and can expose patients to harm, stress, and longer wait times. They are also costly and wasteful for the health-care system. The Choosing Wisely Canada Implementation Research Network (CWC-IRN) is a new national research collaborative focused on tackling the problem of unnecessary tests and treatments in Canada. Dr. Jeremy Grimshaw, working in partnership with Choosing Wisely Canada, recently received the Canadian Institutes for Health Research (CIHR) Innovative Clinical Trial (iCT) grant to support these efforts.
Choosing Wisely Canada has made over 300 recommendations regarding these unnecessary tests and treatments. However, changing behaviour in health care systems is difficult. The CIHR iCT grant led by Dr. Grimshaw and Dr. Sacha Bhatia, focuses on two campaign recommendations: imaging for lower back pain and pre-operative tests like x-rays and echocardiograms before low-risk surgery. Lower back pain is one of the top reasons that people go to a doctor, but 90 percent of cases are not long-lasting. Most people will feel better in a month or so, whether they get an x-ray or not.
“This is about doing the right thing for patients. Unnecessary tests can lead to false positives, which can lead to more testing and possibly unneeded procedures,” said Dr. Grimshaw, a professor at the University of Ottawa and who also leads The Ottawa Hospital Centre for Implementation Research. “There is a lot of research out there on how to make people start doing something, but there’s a lot less on how you get people to stop.”
Brian Johnston, one of the patient partners on the network, helps ensure that the impact of this research on patients is kept front and center. He has been involved in Choosing Wisely Newfoundland and Labrador since it launched.
“It’s a matter of starting the conversation. What’s the why behind this course of treatment, why are we doing it now and not later? Both patients and clinicians will have a role to play,” said the retired student services professional at Memorial University of Newfoundland.
Hospitals and family practices across Ontario, Alberta and Newfoundland and Labrador will participate in this research project. Over the next five years, researchers will investigate what drives overuse, as well as develop and test practical solutions for change. These solutions will be rooted in the behavioural sciences and will inform whether the same solutions can work across all provinces, or whether localized solutions are needed.
“This project of the Choosing Wisely Implementation Research Network is a great opportunity to work with leading researchers across the country to tackle the problem of unnecessary testing, which can have negative impacts on patients and the health system,” said Dr. Sacha Bhatia, Director of Women’s College Hospital Institute for Health System Solutions and Virtual Care and Evaluation Lead for Choosing Wisely Canada.
This cross-Canada implementation research could provide a framework for future approaches at a national level.
“Choosing Wisely Canada is excited to partner with patients and health care providers across the country in a collaborative approach to reducing unnecessary tests and treatments,” said Dr. Wendy Levinson, Chair of Choosing Wisely Canada. “We are proud to help advance research that will help clinicians at the front line avoid unnecessary tests and treatments and improve quality of care to patients.”
Each province involved in the CIHR grant will lead these efforts with the supporting organizations listed below.
The project lead in Alberta is Dr. Shawn Dowling, University of Calgary in partnership with:
- Alberta Health Services
- Alberta Innovates
- Alberta Medical Association
- Choosing Wisely Alberta
- Physician Learning Program
- Strategic Clinical Networks™
- University of Calgary
- Workers’ Compensation Board Alberta
The project leads in Newfoundland and Labrador are Dr. Amanda Hall and Dr. Pat Parfrey, Memorial University, in partnership with:
- Choosing Wisely Newfoundland & Labrador
- Eastern Health Regional Health Authority
- Memorial University
- Newfoundland and Labrador Medical Association
- Newfoundland and Labrador Chiropractic Board
- Newfoundland and Labrador Chiropractic Association
The project leads in Ontario are Dr. Sacha Bhatia, Women’s College Hospital and Dr. Kyle Kirkham, University of Toronto, in partnership with:
- Choosing Wisely Ontario
- Health Quality Ontario
- Life Labs
- Think Research
- University Health Network
- University of Toronto
- Women's College Hospital Institute Health System Solutions & Virtual Care
The Ottawa Hospital: Inspired by research. Driven by compassion
The Ottawa Hospital is one of Canada’s largest learning and research hospitals with over 1,100 beds, approximately 12,000 staff and an annual budget of over $1.2 billion. Our focus on research and learning helps us develop new and innovative ways to treat patients and improve care. As a multi-campus hospital, affiliated with the University of Ottawa, we deliver specialized care to the Eastern Ontario region, but our techniques and research discoveries are adopted around the world. We engage the community at all levels to support our vision for better patient care. See www.ohri.ca for more information about research at The Ottawa Hospital.
University of Ottawa: A crossroads of cultures and ideas
The University of Ottawa is home to over 50,000 students, faculty and staff, who live, work and study in both French and English. Our campus is a crossroads of cultures and ideas, where bold minds come together to inspire game-changing ideas. We are one of Canada’s top 10 research universities—our professors and researchers explore new approaches to today’s challenges. One of a handful of Canadian universities ranked among the top 200 in the world, we attract exceptional thinkers and welcome diverse perspectives from across the globe. www.uottawa.ca
About Choosing Wisely Canada
Choosing Wisely Canada is the national voice for reducing unnecessary tests and treatments in health care. One of its important functions is to help clinicians and patients engage in conversations that lead to smart and effective care choices. Choosing Wisely Canada is organized the University of Toronto, Canadian Medical Association and St. Michael’s Hospital.
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University of Ottawa
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Ottawa Hospital Research Institute
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This article was reprinted with the permission of the Ottawa Hospital Research Institute.