RT Journal Article
SR Electronic
T1 Inappropriate use of clinical practices in Canada: a systematic review
JF Canadian Medical Association Journal
JO CMAJ
FD Canadian Medical Association
SP E279
OP E296
DO 10.1503/cmaj.211416
VO 194
IS 8
A1 Janet E. Squires
A1 Danielle Cho-Young
A1 Laura D. Aloisio
A1 Robert Bell
A1 Stephen Bornstein
A1 Susan E. Brien
A1 Simon Decary
A1 Melissa Demery Varin
A1 Mark Dobrow
A1 Carole A. Estabrooks
A1 Ian D. Graham
A1 Megan Greenough
A1 Doris Grinspun
A1 Michael Hillmer
A1 Tanya Horsley
A1 Jiale Hu
A1 Alan Katz
A1 Christina Krause
A1 John Lavis
A1 Wendy Levinson
A1 Adrian Levy
A1 Michelina Mancuso
A1 Steve Morgan
A1 Letitia Nadalin-Penno
A1 Andrew Neuner
A1 Tamara Rader
A1 Wilmer J. Santos
A1 Gary Teare
A1 Joshua Tepper
A1 Amanda Vandyk
A1 Michael Wilson
A1 Jeremy M. Grimshaw
YR 2022
UL http://www.cmaj.ca/content/194/8/E279.abstract
AB Background: 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.Methods: 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.Results: 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%, n = 9) and thyroid-stimulating hormone (overused, range 3.0%–35.1%, n = 5). The most frequently investigated therapeutics were statin medications (underused, range 18.5%–71.0%, n = 6) and potentially inappropriate medications (overused, range 13.5%–97.3%, n = 9).Interpretation: 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.See related article at www.cmaj.ca/lookup/doi/10.1503/cmaj.220134