Clinical outcome indicators, disease prevalence and test request variability in primary care

Abstract

Aim: To describe differences in biochemistry test request rates (adjusted for practice size) between general practices and to investigate whether differences in HbA 1c and thyroid function test request rates are related either to the practice prevalence of hypothyroidism and diabetes or to Quality and Outcome Framework (QOF) scores. Methods: Information on test request rates, prevalence of diabetes and hypothyroidism, and QOF data over a one-year period were obtained from 58 practices covering a population of 284,609 patients. Spearman's rank correlation tests were used to investigate relationships between adjusted test request rates. Results: There was wide variability in adjusted test request rates (lowest for HbA 1c and highest for immunoglobulins). The ranking of practices for different tests was highly correlated. There was no relationship between adjusted test request rates for HbA 1c and thyroid function and the reported prevalence of diabetes and hypothyroidism, respectively, nor was there any relationship with QOF scores in diabetes and hypothyroidism. Conclusions: There is wide variability in test request rates in general practice that do not appear to be related to disease prevalence or crude clinical outcome measures. 2011; 48: 155-158. Ann Clin Biochem

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“…O'Kane et al . found large variations in test rates for HbA1c and thyroid functions, but no association with disease prevalence or clinical outcome measures . Hippisley‐Cox found no association between overall referral rates and stages of breast and colorectal cancer .…”

“…17 O'Kane et al found large variations in test rates for HbA1c and thyroid functions, but no association with disease prevalence or clinical outcome measures. 18 Hippisley-Cox found no association between overall referral rates and stages of breast and colorectal cancer. 19 A recent study by Shawihdi et al found an association between low gastroscopy referral rate and poorer outcomes of oesophago-gastric cancer regarding emergency admission, major surgery, and mortality.…”

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“…Turchin et al 97 also showed that frequent HbA1c testing in patients with diabetes resulted in shorter time to target HbA1c level, independently of confounders such as initial HbA1c level, treatment-associated factors, frequency of encounters with healthcare professionals and patient demographics. O'Kane et al 24 showed that there was no correlation between the number of HbA1c tests performed and the proportion of patients in general practises with HbA1c of <58 mmol/mol (<7.5%), raising questions over the impact of testing frequency on management. Such data providing clear links between appropriateness of testing and clinical outcomes are needed for demand management interventions if they are to be widely accepted by clinical staff.…”

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“…It is only recently that studies have explored the relationship between testing rate and outcome. O'Kane et al 64 have challenged the concept that the rate of testing is related to outcomes. In contrast, a different study, using glycated haemoglobin as an indicator, has shown that more tests are done in patients with complications, suggesting that the greater testing rate reflected greater clinical activity and was probably appropriate.…”