Table 1.

Low-value care examples and associated time burden in primary care

CLINICAL SCENARIOCHOOSING WISELY CANADA RECOMMENDATIONTIME LOST TO LOW-VALUE CAREKEY ASSUMPTIONS
67-year-old woman, non-smoker, with BMI of 25 is concerned about fractures. Clinician orders BMD test based on age aloneDo not order DEXA screening for fragility fracture on low-risk patients. Use fracture risk-assessment tools firstUsing BMD-first screening, instead of a risk-assessment-first screening approach:
  • Per clinician:
    - 30 min/month
    - 0.75 days/year
    - About 4 weeks over
     25-year career
  • Clinic wide
     (10 clinicians):
    - 7.5 days/year

  • Clinic of 1200 patients (300 women aged ≥65 years)

  • Screening up to 85 years

  • BMD-first screening every 2-5 years; risk-assessment-first screening every 8 years

52-year-old man presents with acute back pain (3 days) after moving boxes and requests x-ray scan, which is orderedDo not order imaging for lower back pain unless red flags are present. Imaging before 6 weeks does not improve outcomesOrdering back x-ray scans before 6 weeks in the absence of red flags:
  • Per clinician:
    - 1 hour/month
    - 1 day/year
    - 5 weeks over
     25-year career
  • Clinic wide
     (10 clinicians):
    - 10 days/year

  • 8 acute care shifts/month with 1 case per shift

  • 1 min to order

  • 1 min to manage normal result

  • 5 min to manage abnormal result

  • 50% abnormal result rate5

43-year-old man requests a routine check-up. Physical examination is done and CBC orderedAvoid routine physical examinations and screening blood tests in asymptomatic adults without risk factors. These practices are not shown to improve mortality or health outcomes and may lead to false positive results and further unnecessary diagnostic testingOrdering a CBC when there is no clinical indication:
  • Per clinician:
    - 1.5 hours/month
    - About 2 days/year
    - 8 weeks over
     25-year career
  • Clinic wide
     (10 clinicians):
    - 20 days/year

  • 5 period examination/week

  • 1 min to order

  • 1 min to manage normal result

  • 3 min to manage abnormal result

  • 15% to 20% abnormal result rate6

  • BMD—bone mineral densitometry, BMI—body mass index, CBC—complete blood count, DEXA—dual-energy x-ray absorptiometry.