COVID-19 Practice Partner

A Pandemic Silver Lining

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COVID-19 presents opportunities to assess the value of certain procedures

As Canada emerges from the pandemic, and health care systems rebuild and begin to address the backlog of delayed or cancelled services, there is an imperative to introduce lasting changes to reduce low-value tests, treatments and procedures, stated panel experts at the national virtual meeting of Choosing Wisely Canada.

Choosing Wisely Canada describes low value care as an important health care quality problem in Canada because it provides little clinical benefit, may be harmful for patients, and wastes limited resources.

The COVID-19 pandemic exposed the realities of a health care system that has been pushed to its limits, said panellist Heather Logan, a senior advisor at the Canadian Agency for Drugs and Technologies in Health (CADTH).

“Now, and beyond the pandemic, health care services face very daunting challenges to address very limited resources, reduced system capacities and growing backlogs — all while simultaneously treating patients with growing complex care needs,” said Ms. Logan.

CADTH, an independent, not-for-profit organization responsible for providing health care decision-makers with objective evidence to help make informed decisions about the optimal use of health technologies, teamed with Choosing Wisely Canada to produce a report on the recommendations.

It is estimated that clearing the backlog of procedures in various jurisdictions will require considerable time and resources. In Ontario, estimates show it may take between nine months and two and half years to clear the backlog of surgical procedures alone.

To help inform efforts for using health care resources wisely and to support decision-making, CADTH and Choosing Wisely Canada convened a 10-member, multi-disciplinary panel of clinicians, patient representatives and health policy experts to review areas of low-value care that can be reduced or limited. This panel reviewed, deliberated and prioritized 19 recommendations of the more than 400 Choosing Wisely Canada recommendations, the implementation of which can help ensure high-value care after the pandemic.

Dr. Ken Milne, a panellist and emergency medicine physician, said he was particularly pleased to see Choosing Wisely highlighted the importance of palliative care in its recommendation. “This is one area that needs to get more attention. Patients deserve agency, dignity and autonomy. There is always something that can be done for them and that something is palliative care.”

The panelists agreed that addressing the problem of low-value care also requires understanding barriers that clinicians and health systems can face when implementing change. Practice habits, perceptions of patient demands and clinical environments can create barriers to reducing low-value care. As such, Choosing Wisely Canada’s framework for reducing low-value care identifies and considers potential barriers and facilitators for implementing recommendations.

Moreover, the panel’s discussion highlighted how the selected recommendations can advance key priorities, including improving health equity and access to care, appropriately using limited resources, emphasizing patient-focused care, and addressing challenges the pandemic has presented for long-term care.

The CADTH-CWC report is available online.

Examples of the 19 recommendations include:

Avoidingunnecessary transfers for patients in long-term care to hospitals, unless there is an urgent medical need.

Limiting blood testsandimaging, unless required to answer a specific clinical question or guide treatment.

Not transfusing red blood cells for hemodynamically stable patients in the intensive care unit.

Not delaying palliative care for patients with serious illness because they are pursuing disease-directed treatment.