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Quality Improvement

Choosing Wisely in Primary Care

Choosing Wisely Canada’s focus in the primary care sector is on the reduction of annual physical exams and unnecessary bundled tests. These recommendations have broad applicability across primary care. Little evidence shows value in many routine tests and blood work in asymptomatic patients. Selecting screening tests for patients should be done with careful consideration of the patient’s age, sex and possible risk factors.

 

Annual exams

Periodic physical examinations allow physicians to check their healthy patients while they are healthy. However, the benefits of a yearly check-up are questionable since many chronic illnesses that benefit from early detection take longer than a year to develop. Preventive health checks should instead be done at time intervals recommended by guidelines, like those from the Canadian Task Force on the Periodic Health Examination.

Primary care sector annual exam recommendation:

  • Don’t do annual physical exams on asymptomatic adults with no significant risk factors

Resources to help choose annual exams wisely:

 

Reduction of bundled tests

Just because a test, treatment or procedure is available, it doesn’t mean it should be used. Most people should only have a test or exam if they have related symptoms or risks factors. Unnecessary tests can lead to false-positive results, which can lead to anxiety, and unnecessary follow-up tests and treatments.

Primary care sector test recommendation:

  • Don’t order dual-energy X-ray absorptiometry (DEXA) screening for osteoporosis on low risk patients

  • Don’t’ screen women with Pap smears if under 21 years of age or over 69 years of age

  • Don’t order screening chest X-rays and ECGs for asymptomatic or low risk outpatients

  • Don’t order thyroid function tests in asymptomatic patients

  • Don’t do annual screening blood tests unless directly indicated by the risk profile of the patient

Resources to help choose primary care tests wisely:

 

Ready to bring Choosing Wisely to your primary care practice?

If you have a question about Choosing Wisely Canada or want to learn more about how to get involved, please email us at CWC@hqontario.ca.

 

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