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 Squires, Janet E.
A1 Cho-Young, Danielle
A1 Aloisio, Laura D.
A1 Bell, Robert
A1 Bornstein, Stephen
A1 Brien, Susan E.
A1 Decary, Simon
A1 Varin, Melissa Demery
A1 Dobrow, Mark
A1 Estabrooks, Carole A.
A1 Graham, Ian D.
A1 Greenough, Megan
A1 Grinspun, Doris
A1 Hillmer, Michael
A1 Horsley, Tanya
A1 Hu, Jiale
A1 Katz, Alan
A1 Krause, Christina
A1 Lavis, John
A1 Levinson, Wendy
A1 Levy, Adrian
A1 Mancuso, Michelina
A1 Morgan, Steve
A1 Nadalin-Penno, Letitia
A1 Neuner, Andrew
A1 Rader, Tamara
A1 Santos, Wilmer J.
A1 Teare, Gary
A1 Tepper, Joshua
A1 Vandyk, Amanda
A1 Wilson, Michael
A1 Grimshaw, Jeremy M.
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