Diagnostic and laboratory test ordering in Northern Portuguese Primary Health Care: a cross-sectional study

Abstract

ObjectivesTo characterise the test ordering pattern in Northern Portugal and to investigate the influence of context-related factors, analysing the test ordered at the level of geographical groups of family physicians and at the level of different healthcare organisations.DesignCross-sectional study.SettingNorthern Primary Health Care, Portugal.ParticipantsRecords about diagnostic and laboratory tests ordered from 2035 family physicians working at the Northern Regional Health Administration, who served approximately 3.5 million Portuguese patients, in 2014.OutcomesTo determine the 20 most ordered diagnostic and laboratory tests in the Northern Regional Health Administration; to identify the presence and extent of variations in the 20 most ordered diagnostic and laboratory tests between the Groups of Primary Care Centres and between health units; and to study factors that may explain these variations.ResultsThe 20 most ordered diagnostic and laboratory tests almost entirely comprise laboratory tests and account for 70.9% of the total tests requested. We can trace a major pattern of test ordering for haemogram, glucose, lipid profile, creatinine and urinalysis. There was a significant difference (P<0.001) in test orders for all tests between Groups of Primary Care Centres and for all tests, except glycated haemoglobin (P=0.06), between health units. Generally, the Personalised Healthcare Units ordered more than Family Health Units.ConclusionsThe results from this study show that the most commonly ordered tests in Portugal are laboratory tests, that there is a tendency for overtesting and that there is a large variability in diagnostic and laboratory test ordering in different geographical and organisational Portuguese primary care practices, suggesting that there may be considerable potential for the rationalisation of test ordering. The existence of Family Health Units seems to be a strong determinant in decreasing test ordering by Portuguese family physicians. Approaches to ensuring more rational testing are needed.

Análise de Normalidade e Impacto Econômico de Exames Laboratoriais em Usuários de Serviço Privado de João Pessoa-PB

“…Os exames laboratoriais apoiam 70% dos diagnósticos e das decisões de tratamento (2) , sendo os mais solicitados e também os responsáveis por maior gasto (3) .…”

“…Os exames mais solicitados se repetem em diversos estudos: ácido úrico, ALT (alanina aminotransferase), AST (aspartato aminotransferase), colesterol total, creatinina, eletrólitos, GGT (gamaglutamil transferase), glicemia, HDL (high-density lipoprotein cholesterol), hemograma, microalbuminúria, triglicerídeos, TSH (hormônio estimulante da tireoide), e ureia (1,3) .…”

Primary care use of laboratory tests in Northern Ireland’s Western Health and Social Care Trust: a cross-sectional study

“…Several studies suggested that unnecessary and inappropriate utilization of laboratory services is closely linked to inter-practitioner variability in test requesting. [6][7][8] Despite the increased availability of clinical management guidelines promoting harmonization of the use of laboratory tests, there is still substantial variation in test utilization among general practitioners. 7,9 These differences appear to be unrelated to demographic characteristics of patient populations, socio-economic status of GP practices, disease prevalence or clinical outcome indicators.…”

“…[6][7][8] Despite the increased availability of clinical management guidelines promoting harmonization of the use of laboratory tests, there is still substantial variation in test utilization among general practitioners. 7,9 These differences appear to be unrelated to demographic characteristics of patient populations, socio-economic status of GP practices, disease prevalence or clinical outcome indicators. 6,7,10,11 Even if some of these variables have been shown to have an effect on test ordering patterns, the variation in requesting rates is so large that it can only be explained by differences in attitudes towards the use of laboratory tests of individual practitioners.…”

“…7,9 These differences appear to be unrelated to demographic characteristics of patient populations, socio-economic status of GP practices, disease prevalence or clinical outcome indicators. 6,7,10,11 Even if some of these variables have been shown to have an effect on test ordering patterns, the variation in requesting rates is so large that it can only be explained by differences in attitudes towards the use of laboratory tests of individual practitioners. 10 Accordingly, factors such as confidence in clinical judgement, clinical experience, an attitude about clinical practice guidelines, a lack of knowledge regarding the correct use of tests and fear of litigation have been identified as potential sources of practice variation.…”