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One in five physicians were responsible for ordering nearly 40 per cent of low-value screening tests


A small group of family doctors are responsible for ordering nearly 40 per cent of at least two out of four low-value screening tests, according to a new study by researchers at the Institute for Clinical Evaluative Sciences (ICES) and Women's College Hospital (WCH).

The study, published today in JAMA Network Open, found that out of the 2,394 primary care physicians included in the study, 18.4 per cent (441 of 2,394) ordered 39.2 per cent of all low-value screening tests in the province.

The four low-value tests that the researchers examined were:

  • Repeat dual-energy x-ray absorptiometry (DXA) scans for patients with a prior DXA scan in the past two years (bone density scan).
  • Electrocardiograms (ECGs) for patients at low risk for cardiovascular disease.
  • Papanicolaou (Pap) tests for women younger than 21 years of age or older than 69 years.
  • Chest x-rays (CXRs) for patients at low risk for cardiopulmonary disease.

The Choosing Wisely campaign, which operates in more than 20 countries worldwide, is dedicated to reducing the frequency of low-value care, which is defined as care that offers little to no patient benefit or a greater risk of harm. 

“Our study results show that, while most physicians show infrequent use of low-value screening tests, there is a minority of physicians who are responsible for a large proportion of all low-value testing ordered,” says Dr. Sacha Bhatia, lead author on the study and ICES adjunct scientist.

Worldwide, Choosing Wisely campaigns have aimed to raise general awareness among physicians and patients on the issue of low-value care. The importance of reducing low-value care is not only to avoid the cost of the initial screening tests but also to prevent unnecessary downstream care that results from false-positive results.

“Our findings suggest that targeted efforts need to be made to reduce low-value care, with tailored strategies towards the minority of physicians who order these kinds of tests and treatments,” says Bhatia.

“Physician characteristics associated with ordering 4 low-value screening tests in primary care,” was published today in JAMA Network Open.

Author block:  Zachary Bouck, Jacob Ferguson, Noah M. Ivers, Eve A. Kerr, Min Kim, Peter Cram, Ciara Pendrith, Graham Mecredy, Richard H. Glazier, Joshua Tepper, Peter C Austin, Wendy Levinson and R Sacha Bhatia.

The Institute for Clinical Evaluative Sciences (ICES) is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy. For the latest ICES news, follow us on Twitter: @ICESOntario

About Women’s College Hospital

For more than 100 years Women’s College Hospital (WCH) has been developing revolutionary advances in healthcare. Today, WCH is a world leader in the health of women and Canada’s leading, academic ambulatory hospital. A champion of equitable access, WCH advocates for the health of all women from diverse cultures and backgrounds and ensures their needs are reflected in the care they receive. It focuses on delivering innovative solutions that address Canada’s most pressing issues related to population health, patient experience and system costs. The WCH Institute for Health System Solutions and Virtual Care (WIHV) is developing new, scalable models of care that deliver improved outcomes for patients and sustainable solutions for the health system as a whole. For the latest on cutting edge research advancing health system solutions, follow @wchwihv on Twitter.

Women’s College Research Institute (WCRI) is tackling some of the greatest health challenges of our time. Its scientists are conducting global research that advances the health of women and improves healthcare options for all, and are then translating those discoveries to provide much-needed improvements in healthcare worldwide. 
For more information about how WCH and WCRI are transforming patient care, visit www.womenscollegehospital.ca and www.womensresearch.ca


Deborah Creatura
Media Advisor, ICES
[email protected]
(o) 416-480-4780 or (c) 647-406-5996

Jennifer Lee
Senior Communications Lead, Strategic Communications, Women’s College Hospital
[email protected]
(o) 416-323-6400 ext. 3218 (c) 647-889-7306


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