Swayed by pharmaceutical sales reps and less than fully versed on new technology, family doctors may be prescribing drugs improperly and ordering too many expensive diagnostic tests, warns a new federal-provincial report.
Governments must give such primary-care physicians the tools to make better decisions if they want to corral spiralling health-care costs, says the Health Council of Canada in a report to be released on Monday.
"Our research points to inappropriate prescribing of drugs and over-use of diagnostic imaging," says the report, Decisions Decisions. "If there is no change in how family physicians are supported in their role as gatekeeper, we can expect a surge in health service use."
The council's head stressed the group is not attacking the competency of the doctors Canadians visit most often, but issuing a "call for action" to help them better assess a barrage of new medications and technologies.
Doctors need better, independent tutoring on optimum use of medication, and more help from radiologists to determine when MRIs, CT scans and other tests are needed, the report says.
The chief organization representing family physicians, however, said the negative appraisal of their work is simply not backed up by the facts, and overlooks research that suggests people with their own family doctor have the best health outcomes.
"All physicians, and anyone who is ordering tests and prescribing drugs, can make mistakes.... It is unfair to single out family physicians," said Dr. Cal Gutkin, CEO of the College of Family Physicians of Canada. "In some ways, it is irresponsible for them to do this."
In fact, he said new practice guidelines in certain areas require family doctors do preparatory work on patients, including ordering MRIs, before the patient is referred to the specialist. In other cases, treatment guidelines drafted by specialists, some of whom are heavily funded by pharmaceutical companies, have resulted in more patients receiving particular drugs, said Dr. Gutkin.
John Abbott, the Health Council's CEO, said family doctors are gatekeepers to the system, and their decisions trigger costs all down the line, through ordering tests, referring patients to specialists and prescribing drugs.
Helping them perform better "doesn't deny service, doesn't add costs," said Mr. Abbott. "It can improve service and improve cost and improve safety."
The report notes that the number of prescriptions filled at community pharmacies has soared 80% in the last decade to 483 million in 2009, with medication the second biggest and fastest growing cost in health care, at about $25-billion yearly. Large proportions of those pills are prescribed by family doctors, it says.
Some of the growth is tied to the aging population, and new pharmaceutical discoveries, the report says.
But studies show wide variations in prescribing patterns from region to region, and questionable prescribing for certain patient groups, pointing to inappropriate decisions by some family doctors, argues the council.
It said the doctors can be "heavily influenced" by the estimated 6,000 drug-firm representatives who pitch their products across Canada, and sometimes do not follow clinical-practice guidelines. They also are inundated with a constant influx of new drugs — almost 900 in the past five years.
The report recommends family physicians adhere more closely to those guidelines and adopt electronic prescribing, and that governments fund more "academic detailing" — drug reps who give doctors impartial assessments of medication.
The council notes that provinces have invested heavily in diagnostic imaging like MRI and CT scanning in recent years but that wait lists still persist.
As family doctors play an increasing role in ordering the scans, it cites estimates from the Canadian Association of Radiologists that as many as 30% of tests are inappropriate or unhelpful.
