RT Journal Article SR Electronic T1 Frequency of and variation in low-value care in primary care: a retrospective cohort study JF CMAJ Open FD Canadian Medical Association SP E45 OP E51 DO 10.9778/cmajo.20160095 VO 5 IS 1 A1 Ciara Pendrith A1 Meghan Bhatia A1 Noah M. Ivers A1 Graham Mecredy A1 Karen Tu A1 Gillian A. Hawker A1 Susan B. Jaglal A1 Lynn Wilson A1 Kimberly Wintemute A1 Richard H. Glazier A1 Wendy Levinson A1 R. Sacha Bhatia YR 2017 UL http://www.cmajopen.ca/content/5/1/E45.abstract AB Background: Low-value care, defined as care with a lack of benefit, can lead to higher health care costs, inconvenience to patients and, in some cases, harm to patients. The objectives of this study are to conduct exploratory analyses to understand how frequently selected low-value tests are ordered, to assess the degree of variation in ordering that exists across regions and practices, and to identify services that may warrant further investigation and targeted interventions.Methods: We conducted a population-based retrospective cohort study using administrative health care databases from Ontario to identify rates of use of the following low-value services between fiscal years 2008/09 and 2012/13: computed tomography (CT) or magnetic resonance imaging (MRI) after a diagnosis of low back pain, Papanicolaou testing in women less than 21 years of age or older than 69 years of age and repeated dual-energy X-ray absorptiometry (DEXA) scanning within 2 years of an index scan. Regional and practice-level rates were calculated. Bivariate analyses were conducted to explore associations between patient factors and repeat DEXA scans.Results: Repeated DEXA scans were the most common service (21.0%), whereas cervical cancer screening among women less than 21 years of age or older than 69 years of age (8.0%) and CT or MRI imaging for low back pain (4.5%) were less common. There was substantial variation across practices with rates of repeated DEXA scans, ranging from 4.0% to 54.9%, and cervical cancer screening, ranging from 0.9% to 35.2%. Patients with a high-risk index DEXA were more likely to receive a repeat scan (28.1%) than those with a baseline (8.9%) or low-risk (8.1%) scan.Interpretation: There is significant, practice-level variation in the frequency of low-value testing for DEXA scans, back imaging and cervical cancer screening. There is a particular need for interventions that aim to reduce unnecessary DEXA scans.