C.D. Howe report urges measures to curb inappropriate medical testing

Misuse of laboratory testing in Canada is costly and potentially harmful, according to a new report from the C.D. Howe Institute.

Over-used tests may lead to inaccurate diagnosis and potentially inappropriate treatments

An MRI scanner in Charlottetown. Tests are considered appropriate if they aid diagnosis, treatment or subsequent monitoring of a patient's condition. (Laura Meader/CBC)

A new report urges several measures to curb inappropriate lab tests that it says strain the health-care system and hinder patient care.

The report from the C.D. Howe Institute says over-used tests may lead to inaccurate diagnosis and potentially inappropriate treatments that can cause adverse side-effects.

The authors say the problem varies by test, but cites one 2013 study that estimates 16 per cent to 56 per cent are inappropriate.

The think tank says the issue varies across the country, citing data from the Canadian Institute for Health Information that suggests hospital tests in New Brunswick and Newfoundland — including general radiography, mammography, ultrasound, and magnetic resonance imaging — was more than twice the rate seen in Alberta and Saskatchewan.

Canadians receive an average of 14 to 20 laboratory tests per year, with about 70 per cent of medical decisions based on the results. The authors say that works out to roughly $5.9 billion spent annually on lab work, or four per cent of health-care budgets.

The report, titled "What the Doctor Ordered: Improving the Use and Value of Laboratory Testing," adds that under-used tests are also a problem, noting that when a necessary test is not ordered, it delays diagnosis and treatment and can worsen a patient's condition. However, that issue is harder to track, the authors note.

The study suggests doctors be given regular feedback on how their testing habits compare to peers, that they be paid per patient rather than per service, and that testing be restricted to patients that fall within minimum guidelines.

"Inappropriate use of laboratory diagnostics serves no medical value and results in costs to patients, physicians and the health-care system overall," says Thursday's study, co-authored by C.D. Howe analyst Rosalie Wyonch and Christopher Naugler, department head and professor of Pathology and Laboratory Medicine at the University of Calgary.

Dangers of over-testing 

Tests are considered appropriate if they aid diagnosis, treatment or subsequent monitoring of a patient's condition. They are inappropriate if they don't fall within clinical guidelines or are reordered before results are likely to change.

The study knits together several findings that document the dangers of over-testing, including a national education campaign by Choosing Wisely Canada that listed more than 150 commonly used tests, treatments and procedures as unsupported by evidence.

Meanwhile, a 2017 investigation by the Canadian Institute for Health Information found up to 30 per cent of tests, procedures and treatments associated with eight tests were potentially unnecessary.

The issue has not gone unnoticed — a 2015 survey of public perceptions suggested about one-quarter of Canadians felt they were recommended an unnecessary test or treatment.

The think tank says the current fee-for-service model encourages doctors to perform as many services as possible.

Instead, they argue for remuneration based on the expected needs of individual patients, with doctors paid more for patients that likely require more medical care.

"In this model, physicians are paid to deliver a basket of services and are paid per patient, not per service."

They also call for more comprehensive electronic medical records to avoid inappropriate test reordering, and requisition forms that restrict tests to patients who fall within the practice guidelines.

"If physicians are obliged to provide the reason for ordering a particular test, they are much less likely to inappropriately order it."


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