Inappropriate use of clinical practices in Canada: a systematic review
Inappropriate health care leads to negative patient experiences, poor health outcomes and inefficient use of resources. We aimed to conduct a systematic review of inappropriately used clinical practices in Canada. We searched multiple bibliometric databases and grey literature to identify inappropri...
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| Veröffentlicht in: | Canadian Medical Association journal (CMAJ) 2022-02, Vol.194 (8), p.E279-E296 |
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| creator | Squires, Janet E Cho-Young, Danielle Aloisio, Laura D Bell, Robert Bornstein, Stephen Brien, Susan E Decary, Simon Varin, Melissa Demery Dobrow, Mark Estabrooks, Carole A Graham, Ian D Greenough, Megan Grinspun, Doris Hillmer, Michael Horsley, Tanya Hu, Jiale Katz, Alan Krause, Christina Lavis, John Levinson, Wendy Levy, Adrian Mancuso, Michelina Morgan, Steve Nadalin-Penno, Letitia Neuner, Andrew Rader, Tamara Santos, Wilmer J Teare, Gary Tepper, Joshua Vandyk, Amanda Wilson, Michael Grimshaw, Jeremy M |
| description | Inappropriate health care leads to negative patient experiences, poor health outcomes and inefficient use of resources. We aimed to conduct a systematic review of inappropriately used clinical practices in Canada.
We searched multiple bibliometric databases and grey literature to identify inappropriately used clinical practices in Canada between 2007 and 2021. Two team members independently screened citations, extracted data and assessed methodological quality. Findings were synthesized in 2 categories: diagnostics and therapeutics. We reported ranges of proportions of inappropriate use for all practices. Medians and interquartile ranges (IQRs), based on the percentage of patients not receiving recommended practices (underuse) or receiving practices not recommended (overuse), were calculated. All statistics are at the study summary level.
We included 174 studies, representing 228 clinical practices and 28 900 762 patients. The median proportion of inappropriate care, as assessed in the studies, was 30.0% (IQR 12.0%-56.6%). Underuse (median 43.9%, IQR 23.8%-66.3%) was more frequent than overuse (median 13.6%, IQR 3.2%-30.7%). The most frequently investigated diagnostics were glycated hemoglobin (underused, range 18.0%-85.7%,
= 9) and thyroid-stimulating hormone (overused, range 3.0%-35.1%,
= 5). The most frequently investigated therapeutics were statin medications (underused, range 18.5%-71.0%,
= 6) and potentially inappropriate medications (overused, range 13.5%-97.3%,
= 9).
We have provided a summary of inappropriately used clinical practices in Canadian health care systems. Our findings can be used to support health care professionals and quality agencies to improve patient care and safety in Canada. |
| doi_str_mv | 10.1503/cmaj.211416 |
| format | Article |
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We searched multiple bibliometric databases and grey literature to identify inappropriately used clinical practices in Canada between 2007 and 2021. Two team members independently screened citations, extracted data and assessed methodological quality. Findings were synthesized in 2 categories: diagnostics and therapeutics. We reported ranges of proportions of inappropriate use for all practices. Medians and interquartile ranges (IQRs), based on the percentage of patients not receiving recommended practices (underuse) or receiving practices not recommended (overuse), were calculated. All statistics are at the study summary level.
We included 174 studies, representing 228 clinical practices and 28 900 762 patients. The median proportion of inappropriate care, as assessed in the studies, was 30.0% (IQR 12.0%-56.6%). Underuse (median 43.9%, IQR 23.8%-66.3%) was more frequent than overuse (median 13.6%, IQR 3.2%-30.7%). The most frequently investigated diagnostics were glycated hemoglobin (underused, range 18.0%-85.7%,
= 9) and thyroid-stimulating hormone (overused, range 3.0%-35.1%,
= 5). The most frequently investigated therapeutics were statin medications (underused, range 18.5%-71.0%,
= 6) and potentially inappropriate medications (overused, range 13.5%-97.3%,
= 9).
We have provided a summary of inappropriately used clinical practices in Canadian health care systems. Our findings can be used to support health care professionals and quality agencies to improve patient care and safety in Canada.</description><identifier>ISSN: 0820-3946</identifier><identifier>EISSN: 1488-2329</identifier><identifier>DOI: 10.1503/cmaj.211416</identifier><identifier>PMID: 35228321</identifier><language>eng</language><publisher>Canada: CMA Joule Inc</publisher><subject>Canada ; Humans ; Inappropriate Prescribing - statistics & numerical data ; Medical care ; Medical Overuse - statistics & numerical data ; Medical research ; Medicine ; Medicine, Experimental ; Overtreatment - statistics & numerical data ; Patient Satisfaction ; Practice ; Quality management ; Quality of Health Care</subject><ispartof>Canadian Medical Association journal (CMAJ), 2022-02, Vol.194 (8), p.E279-E296</ispartof><rights>2022 CMA Impact Inc. or its licensors.</rights><rights>COPYRIGHT 2022 CMA Joule Inc.</rights><rights>2022 CMA Impact Inc. or its licensors 2022</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c612t-5395b0fd43abaa10bcb31a85827324b50f26d4287e13f5a259ed6f6f90893a483</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC9053971/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC9053971/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,27901,27902,53766,53768</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35228321$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Squires, Janet E</creatorcontrib><creatorcontrib>Cho-Young, Danielle</creatorcontrib><creatorcontrib>Aloisio, Laura D</creatorcontrib><creatorcontrib>Bell, Robert</creatorcontrib><creatorcontrib>Bornstein, Stephen</creatorcontrib><creatorcontrib>Brien, Susan E</creatorcontrib><creatorcontrib>Decary, Simon</creatorcontrib><creatorcontrib>Varin, Melissa Demery</creatorcontrib><creatorcontrib>Dobrow, Mark</creatorcontrib><creatorcontrib>Estabrooks, Carole A</creatorcontrib><creatorcontrib>Graham, Ian D</creatorcontrib><creatorcontrib>Greenough, Megan</creatorcontrib><creatorcontrib>Grinspun, Doris</creatorcontrib><creatorcontrib>Hillmer, Michael</creatorcontrib><creatorcontrib>Horsley, Tanya</creatorcontrib><creatorcontrib>Hu, Jiale</creatorcontrib><creatorcontrib>Katz, Alan</creatorcontrib><creatorcontrib>Krause, Christina</creatorcontrib><creatorcontrib>Lavis, John</creatorcontrib><creatorcontrib>Levinson, Wendy</creatorcontrib><creatorcontrib>Levy, Adrian</creatorcontrib><creatorcontrib>Mancuso, Michelina</creatorcontrib><creatorcontrib>Morgan, Steve</creatorcontrib><creatorcontrib>Nadalin-Penno, Letitia</creatorcontrib><creatorcontrib>Neuner, Andrew</creatorcontrib><creatorcontrib>Rader, Tamara</creatorcontrib><creatorcontrib>Santos, Wilmer J</creatorcontrib><creatorcontrib>Teare, Gary</creatorcontrib><creatorcontrib>Tepper, Joshua</creatorcontrib><creatorcontrib>Vandyk, Amanda</creatorcontrib><creatorcontrib>Wilson, Michael</creatorcontrib><creatorcontrib>Grimshaw, Jeremy M</creatorcontrib><title>Inappropriate use of clinical practices in Canada: a systematic review</title><title>Canadian Medical Association journal (CMAJ)</title><addtitle>CMAJ</addtitle><description>Inappropriate health care leads to negative patient experiences, poor health outcomes and inefficient use of resources. We aimed to conduct a systematic review of inappropriately used clinical practices in Canada.
We searched multiple bibliometric databases and grey literature to identify inappropriately used clinical practices in Canada between 2007 and 2021. Two team members independently screened citations, extracted data and assessed methodological quality. Findings were synthesized in 2 categories: diagnostics and therapeutics. We reported ranges of proportions of inappropriate use for all practices. Medians and interquartile ranges (IQRs), based on the percentage of patients not receiving recommended practices (underuse) or receiving practices not recommended (overuse), were calculated. All statistics are at the study summary level.
We included 174 studies, representing 228 clinical practices and 28 900 762 patients. The median proportion of inappropriate care, as assessed in the studies, was 30.0% (IQR 12.0%-56.6%). Underuse (median 43.9%, IQR 23.8%-66.3%) was more frequent than overuse (median 13.6%, IQR 3.2%-30.7%). The most frequently investigated diagnostics were glycated hemoglobin (underused, range 18.0%-85.7%,
= 9) and thyroid-stimulating hormone (overused, range 3.0%-35.1%,
= 5). The most frequently investigated therapeutics were statin medications (underused, range 18.5%-71.0%,
= 6) and potentially inappropriate medications (overused, range 13.5%-97.3%,
= 9).
We have provided a summary of inappropriately used clinical practices in Canadian health care systems. Our findings can be used to support health care professionals and quality agencies to improve patient care and safety in Canada.</description><subject>Canada</subject><subject>Humans</subject><subject>Inappropriate Prescribing - statistics & numerical data</subject><subject>Medical care</subject><subject>Medical Overuse - statistics & numerical data</subject><subject>Medical research</subject><subject>Medicine</subject><subject>Medicine, Experimental</subject><subject>Overtreatment - statistics & numerical data</subject><subject>Patient Satisfaction</subject><subject>Practice</subject><subject>Quality management</subject><subject>Quality of Health Care</subject><issn>0820-3946</issn><issn>1488-2329</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqV0s9rFDEUB_BBFLutnrzLoCCKzJpfM5vxIJTF6kJR8Mc5vMm87KbMJNNJprX_vVm2ll3Yi8khkHzyfYG8LHtByZyWhH_QPVzNGaWCVo-yGRVSFoyz-nE2I5KRgteiOslOQ7giaXC2eJqd8JIxyRmdZRcrB8Mw-mG0EDGfAube5Lqzzmro8mEEHa3GkFuXL8FBCx9zyMNdiNhDOslHvLF4-yx7YqAL-Px-Pct-X3z-tfxaXH7_slqeXxa6oiwWJa_LhphWcGgAKGl0wynIUrIFZ6IpiWFVK5hcIOWmBFbW2FamMjWRNQch-Vn2aZc7TE2PrUYXR-hUen0P453yYNXhibMbtfY3qiap9oKmgLf3AaO_njBE1dugsevAoZ-CYhUXsqSi2tZ6vaNr6FBZZ3xK1FuuzqtacElEyZIqjqg1OkzlvUNj0_aBf3XE68Feq300P4LSbLG3-mjqu4MLyUT8E9cwhaBWP3_8h_12aN_s2Q1CFzfBd1O03oVD-H4H9ehDGNE8_AklatumatumatemSb_c_8YH-68v-V-6_d22</recordid><startdate>20220228</startdate><enddate>20220228</enddate><creator>Squires, Janet E</creator><creator>Cho-Young, Danielle</creator><creator>Aloisio, Laura D</creator><creator>Bell, Robert</creator><creator>Bornstein, Stephen</creator><creator>Brien, Susan E</creator><creator>Decary, Simon</creator><creator>Varin, Melissa Demery</creator><creator>Dobrow, Mark</creator><creator>Estabrooks, Carole A</creator><creator>Graham, Ian D</creator><creator>Greenough, Megan</creator><creator>Grinspun, Doris</creator><creator>Hillmer, Michael</creator><creator>Horsley, Tanya</creator><creator>Hu, Jiale</creator><creator>Katz, Alan</creator><creator>Krause, Christina</creator><creator>Lavis, John</creator><creator>Levinson, Wendy</creator><creator>Levy, Adrian</creator><creator>Mancuso, Michelina</creator><creator>Morgan, Steve</creator><creator>Nadalin-Penno, Letitia</creator><creator>Neuner, Andrew</creator><creator>Rader, Tamara</creator><creator>Santos, Wilmer J</creator><creator>Teare, Gary</creator><creator>Tepper, Joshua</creator><creator>Vandyk, Amanda</creator><creator>Wilson, Michael</creator><creator>Grimshaw, Jeremy M</creator><general>CMA Joule Inc</general><general>CMA Impact Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>ISN</scope><scope>ISR</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20220228</creationdate><title>Inappropriate use of clinical practices in Canada: a systematic review</title><author>Squires, Janet E ; 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We aimed to conduct a systematic review of inappropriately used clinical practices in Canada.
We searched multiple bibliometric databases and grey literature to identify inappropriately used clinical practices in Canada between 2007 and 2021. Two team members independently screened citations, extracted data and assessed methodological quality. Findings were synthesized in 2 categories: diagnostics and therapeutics. We reported ranges of proportions of inappropriate use for all practices. Medians and interquartile ranges (IQRs), based on the percentage of patients not receiving recommended practices (underuse) or receiving practices not recommended (overuse), were calculated. All statistics are at the study summary level.
We included 174 studies, representing 228 clinical practices and 28 900 762 patients. The median proportion of inappropriate care, as assessed in the studies, was 30.0% (IQR 12.0%-56.6%). Underuse (median 43.9%, IQR 23.8%-66.3%) was more frequent than overuse (median 13.6%, IQR 3.2%-30.7%). The most frequently investigated diagnostics were glycated hemoglobin (underused, range 18.0%-85.7%,
= 9) and thyroid-stimulating hormone (overused, range 3.0%-35.1%,
= 5). The most frequently investigated therapeutics were statin medications (underused, range 18.5%-71.0%,
= 6) and potentially inappropriate medications (overused, range 13.5%-97.3%,
= 9).
We have provided a summary of inappropriately used clinical practices in Canadian health care systems. Our findings can be used to support health care professionals and quality agencies to improve patient care and safety in Canada.</abstract><cop>Canada</cop><pub>CMA Joule Inc</pub><pmid>35228321</pmid><doi>10.1503/cmaj.211416</doi><tpages>18</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0820-3946 |
| ispartof | Canadian Medical Association journal (CMAJ), 2022-02, Vol.194 (8), p.E279-E296 |
| issn | 0820-3946 1488-2329 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_9053971 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; PubMed Central; Alma/SFX Local Collection |
| subjects | Canada Humans Inappropriate Prescribing - statistics & numerical data Medical care Medical Overuse - statistics & numerical data Medical research Medicine Medicine, Experimental Overtreatment - statistics & numerical data Patient Satisfaction Practice Quality management Quality of Health Care |
| title | Inappropriate use of clinical practices in Canada: a systematic review |
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