Effect of a Controlled Feedback Intervention on Laboratory Test Ordering by Community Physicians

Bunting, Peter S.; Walraven, Carl van

doi:10.1373/clinchem.2003.025098

Cited by 75 publications

(45 citation statements)

References 27 publications

(29 reference statements)

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“…[29][30][31] However, research suggests that they generally lag behind best practice, are often supported by poor evidence, and GP adherence may be low. [32][33][34] Numerous other, more intensive, interventions, such as tailored education/ feedback, [35][36][37][38] decision support, 39,40 redesign of test-order forms, 41 and physician quality Funding This project was funded by the MRC Methodology Research Panel Grant 'Making diagnostic systematic reviews fit for purpose: improving decision making in the NHS' (Grant Number: G0801405).…”

mentioning

confidence: 99%

Temporal growth and geographic variation in the use of laboratory tests by NHS general practices: using routine data to identify research priorities

Busby

Schroeder²,

Woltersdorf

et al. 2013

Br J Gen Pract

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BackgroundLaboratory tests are extensively used for diagnosis and monitoring in UK primary care. Test usage by GPs, and associated costs, have grown substantially in recent years. AimThis study aimed to quantify temporal growth and geographic variation in utilisation of laboratory tests. Design and settingRetrospective cohort study using data from general practices in the UK. MethodData from the General Practice Research Database, including patient demographics, clinical details, and laboratory test results, were used to estimate rates of change in utilisation between 2005 and 2009, and identify tests with greatest inter-regional variation, by fitting random-effects Poisson regression models. The study also investigated indications for test requests, using diagnoses and symptoms recorded in the 2 weeks before each test. ResultsAround 660 000 tests were recorded in 230 000 person-years of follow-up. Test use increased by 24.2%, from 23 872 to 29 644 tests per 10 000 person-years, between 2005 and 2009. Tests with the largest increases were faecal occult blood (121%) and C-reactive protein (86%). There was substantial geographic variation in test utilisation; GPs in some regions requested tests such as plasma viscosity and cardiac enzymes at a rate more than three times the national average. ConclusionIncreases in the use of laboratory tests have substantial resource implications. Rapid increases in particular tests may be supported by evidence-based guidelines, but these are often vague about who should be tested, how often, and for how long. Substantial regional variation in test use may reflect uncertainty about diagnostic accuracy and appropriate indications for the laboratory test. There is a need for further research on the diagnostic accuracy, therapeutic impact, and effect on patient health outcomes of the most rapidly increasing and geographically variable tests.

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mentioning

confidence: 99%

Temporal growth and geographic variation in the use of laboratory tests by NHS general practices: using routine data to identify research priorities

Busby

Schroeder²,

Woltersdorf

et al. 2013

Br J Gen Pract

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“…This is not surprising given that the decision to order a test in an individual patient ultimately rests with the individual doctor. Evidence suggests that doctors with more clinical experience, confidence in their clinical judgment [5,6,22], pride in their work [5], and who do not fear risk taking or uncertainty [1,5,16,22,28] tend to request fewer tests than those who dislike uncertainty and have less experience. Doctor demographics appear to influence test ordering.…”

Section: Doctor-related Factorsmentioning

confidence: 99%

“…Involvement in research, specifically in guideline development, was found to reduce the number of tests requested [10]. Another factor found to reduce test ordering was giving doctors feedback on how their test ordering rates compared to colleagues [8,10,16]. Cognitive biases influence the diagnostic process as a whole, and thus inevitably impact on test ordering [23,24].…”

Section: Doctor-related Factorsmentioning

confidence: 99%

A review identifies and classifies reasons for ordering diagnostic tests

Whiting¹,

Toerien²,

Salis³

et al. 2007

Journal of Clinical Epidemiology

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Article:Whiting, P., Toerien, M. orcid.org/0000-0003-3159-0931, de Salis, I. et al. (4 more ReuseUnless indicated otherwise, fulltext items are protected by copyright with all rights reserved. The copyright exception in section 29 of the Copyright, Designs and Patents Act 1988 allows the making of a single copy solely for the purpose of non-commercial research or private study within the limits of fair dealing. The publisher or other rights-holder may allow further reproduction and re-use of this version -refer to the White Rose Research Online record for this item. Where records identify the publisher as the copyright holder, users can verify any specific terms of use on the publisher's website. TakedownIf you consider content in White Rose Research Online to be in breach of UK law, please notify us by emailing eprints@whiterose.ac.uk including the URL of the record and the reason for the withdrawal request. REVIEW ARTICLESA review identifies and classifies reasons for ordering diagnostic tests Study Design and Setting: We reviewed any study of any design that discussed factors that may affect a doctor's decision to order a test. Articles were located through searches of electronic databases, authors' files on diagnostic methodology, and reference lists of relevant studies. We extracted data on: study design, type of analysis, setting, topic area, and any factors reported to influence test ordering.Results: We included 37 studies. We carried out a thematic analysis to synthesize data. Five key groupings arose from this process: diagnostic factors, therapeutic and prognostic factors, patient-related factors, doctor-related factors, and policy and organization-related factors. To illustrate how the various factors identified may influence test ordering we considered the symptom low back pain and the diagnosis multiple sclerosis as examples.Conclusions: A wide variety of factors influence a doctor's decision to order a test. These are integral to understanding diagnosis in clinical practice. Traditional diagnostic accuracy studies should be supplemented with research into the broader context in which doctors perform their work. Ó

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“…Continuous education of medical doctors has been demonstrated as an effective means for decreasing redundant tests ordering in the hospital setting (16) as well as by practicing community physicians (17).…”

mentioning

confidence: 99%

Efficiency of test report delivery to the requesting physician in an outpatient setting: an observational study

Šimundić

Nikolac²,

Miler³

et al. 2009

Clinical Chemistry and Laboratory Medicine

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Background: Clinical laboratories accredited according to ISO 15189 quality standards are obliged to implement and continuously monitor quality indicators for evaluation of the laboratory's contribution to patient care. Reporting laboratory results to the requesting physician is one important phase of the clinical laboratory testing process. Failure to report results may indicate the ineffectiveness of the laboratory service. We aimed to analyze the proportion and type of laboratory reports for outpatients that were not delivered to the requesting physician. Methods: This retrospective observational study was conducted during an 11-month period from January to December 2007 at our outpatient biochemistry laboratory unit. Data on demographic characteristics, request types and laboratory findings for all uncollected reports were retrieved from the laboratory information system and compared with one random 2-week representative period. Results: During the study period our laboratory issued 22,445 patient reports with more than 150,000 biochemistry analyses. Of these, 464 (2.1%) were uncollected laboratory reports. When compared to the representative period, patients who never collected their laboratory reports were younger (p-0.001) or suffering from some chronic disease. Routine biochemistry tests were the most prevalent ()50%). The majority of routine biochemistry tests were almost equally represented during the study and representative period, while molecular diagnostic tests were several times more frequently uncollected (p-0.001). Reports with electrolytes, metabolites and glucose were the least likely to be uncollected (p-0.001). The total cost for those tests was 30% of the average monthly laboratory budget. Conclusions: A significant amount of the laboratory budget is wasted for tests that never reach the requesting physician. Such misutilization of the laboratory reveals the substantial lack of medical necessity for test requests. Further studies are needed to explore the possible efficiency of the various inter-

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Effect of a Controlled Feedback Intervention on Laboratory Test Ordering by Community Physicians

Cited by 75 publications

References 27 publications

Temporal growth and geographic variation in the use of laboratory tests by NHS general practices: using routine data to identify research priorities

Temporal growth and geographic variation in the use of laboratory tests by NHS general practices: using routine data to identify research priorities

A review identifies and classifies reasons for ordering diagnostic tests

Efficiency of test report delivery to the requesting physician in an outpatient setting: an observational study

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