{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T15:38:13Z","timestamp":1791041893997,"version":"4.1.0"},"reference-count":28,"publisher":"BMJ","issue":"5","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Qual Saf"],"accepted":{"date-parts":[[2017,8,31]]},"published-print":{"date-parts":[[2018,5]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To determine how frequently 10 low-value services highlighted by Choosing Wisely are done and what factors influence their provision.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This is a retrospective cohort study using routinely collected health data from five linked data sets from 2012 to 2015 in the Canadian province of Alberta to determine the frequency with which 10 low-value services were provided.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Between 2012 and 2015, 162\u2009143 people (4% of all 3\u2009814\u2009536 adult Albertans and 5% of the 3\u2009 423 135 who saw a physician at least once in that time frame) received at least one of the 10 low-value services, including 29.8% of Albertans older than 75 years (57\u2009811 of 194\u2009068). The proportion of adults receiving low-value services ranged from carotid artery imaging in 0.1% of asymptomatic adults without cerebrovascular disease, to prostate-specific antigen (PSA) testing in 55.5% of men 75 years or older without a history of prostate cancer. Although age, Charlson scores and frequency of primary care visits were associated with low-value service provision, the directions of the association differed across services; however, higher socioeconomic status, increased frequency of specialist contact and higher ratio of specialists to primary care physicians in the patient\u2019s region were associated with an increased risk of receiving all of the low-value services we examined. The low-value services which resulted in the greatest costs to the healthcare system were cervical cancer screening in women older than 65 without history of cervical dysplasia or genital cancer, PSA testing in men older than 75 without history of prostate cancer and preoperative stress testing\/cardiac imaging before non-cardiac surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Even within a universal coverage healthcare system, the proportion of patients receiving low-value services varied widely (from &lt;0.1%\u2009to 56%). Increased use was associated with higher socioeconomic status, increased frequency of specialist contact and higher ratio of specialists to primary care physicians.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjqs-2017-006778","type":"journal-article","created":{"date-parts":[[2017,9,14]],"date-time":"2017-09-14T21:00:30Z","timestamp":1505422830000},"page":"340-346","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":56,"title":["Frequency of low-value care in Alberta, Canada: a retrospective cohort study"],"prefix":"10.1136","volume":"27","author":[{"given":"Finlay A","family":"McAlister","sequence":"first","affiliation":[{"name":"Division of General Internal Medicine, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meng","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of 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