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Testing and treatment

Provincial collaboration working to de-implement low value health care


By Michelle Osmond

Up to 30 per cent of tests and treatments given to patients are not needed.

In addition to wasting money for patients and the health system, this can lead to significant inconvenience and potential harm for patients without any benefit.

Faculty of Medicine, Primary Healthcare Research Unit, research, health care
Dr. Amanda Hall is the Implementation Research Network lead for Choosing Wisely N.L.
Photo: Submitted

A new research network looking at solutions for de-implementing this low value care received a boost in funding recently. The Implementation Research Network, part of Choosing Wisely Canada (CWC), will receive $1.5 million over four years for research spanning three provinces, including Newfoundland and Labrador.

Changing practice

CWC is engaging patients and health professionals to develop 280 recommendations about tests and treatments that should be avoided in certain situations.

The project links CWC, Choosing Wisely provincial campaigns, patient and health system partners in three provinces — Alberta, Ontario and Newfoundland and Labrador — with leading implementation scientists across the country.

It’s an ambitious research program to develop and test solutions which target both health-care professionals and patients to do two things: reduce unnecessary imaging for patients with low back pain and reduce pre-operative testing for patients having a low-risk surgery, a campaign known as Drop the Pre-op.

“This is the next key step to help health professionals change the way they practice.” — Dr. Amanda Hall

The Implementation Research Network lead for Choosing Wisely N.L. is Dr. Amanda Hall, who is with the Primary Healthcare Research Unit in the Faculty of Medicine.

“This is an important program of work because it will not only help ensure we are delivering appropriate care to patients, but it will also identify the best ways of doing it,” noted Dr. Hall. “This is the next key step to help health professionals change the way they practice.”

The researchers agree it’s not an easy thing to change health care processes. Dr. Hall says that Newfoundland and Labrador is “a little further ahead” in its research on managing low back pain, and that the other two provinces will be learning from this province’s experiences.

“It is a great collaborative environment that could help support real change and ultimately improvement in patient care,” Dr. Hall said.

Dr. Hall also says that working with the Canadian Institute of Health Information will allow the researchers to use data already routinely collected to measure whether the solutions worked.

“If our solutions work, we’ll engage our partners to spread and scale them across Canada.”

Improving the system

The project is being led by Dr. Jeremy Grimshaw, from the Ottawa Hospital Research Institute, and Dr. Sacha Bhatia, from the Women’s College Hospital in Toronto.

The Memorial University arm of the project is being led by Dr. Hall and Dr. Pat Parfrey, as well as partners with Choosing Wisely N.L., Eastern Health Regional Health Authority, Newfoundland and Labrador Medical Association and the Newfoundland and Labrador Chiropractic Association.

The research is made possible by the Strategy for Patient-Oriented Research (SPOR), a series of funding partnerships between the Canadian Institutes of Health Research, provinces and territories, philanthropic organizations, academic institutions and health charities. At its core, SPOR is about providing the evidence needed to inform the development of health policies and improve the health-care system for patients.

The project will roll out over the next four years with support from the Canadian Institute of Health Research’s SPOR Innovative Clinical Trials, which emphasize collaboration between patients, decision-makers and stakeholders.

The Innovative Clinical Trials initiative includes additional funding of $13.3 million from partners, for a total investment of $22.6 million.

To date, the Government of Canada, through the Canadian Institutes of Health Research, has invested $32 million in innovative clinical trials research, and this latest round of funding builds on this strong research base.

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