Why do patients want to have their blood tested? A qualitative study of patient expectations in general practice

Bokhoven, Marloes Amantia van; Empel, Marjolein C H Pleunis-van; Koch, Hèlen; Grol, Richard; Dinant, Geert-Jan; Weijden, Trudy van der

doi:10.1186/1471-2296-7-75

Cited by 52 publications

(41 citation statements)

References 16 publications

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“…This may increasingly be the case, as many patients now see a blood test as the most reliable diagnostic tool at the GP's disposal. 82,84,85 The countervailing risks of embarking on an investigation 'cascade' , triggered by a false-positive test, seem to weigh less highly with patients.…”

Section: Relationship To Existing Literaturementioning

confidence: 99%

Birmingham and Lambeth Liver Evaluation Testing Strategies (BALLETS): a prospective cohort study

Lilford

Bentham²,

Girling³

et al. 2013

Health Technol Assess

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Section: Relationship To Existing Literaturementioning

confidence: 99%

Birmingham and Lambeth Liver Evaluation Testing Strategies (BALLETS): a prospective cohort study

Lilford

Bentham²,

Girling³

et al. 2013

Health Technol Assess

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“…12 Inappropriate test use has also been attributed to factors such as patient pressure and the use of 'defensive' diagnostic testing to reduce malpractice liability. 13,14 As budgets tighten and UK GPs become responsible for commissioning decisions, and ultimately laboratory budgets, there will be increased incentives for more cost-effective use of laboratory tests.…”

Section: Introductionmentioning

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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“…Studies have shown that many patients arrive at appointments with an expectation that they will receive a diagnostic test, a specialty referral, and or a prescription. Table 1 3,4,9 Research on patient attitudes toward cancer screening tests have shown that most Americans think standard screening tests are almost always a good idea and cannot do much harm. 11,15 Further, Americans seem resistant to the idea of doing less.…”

Section: Discussionmentioning

confidence: 99%

“…The reported prevalence of such expectations ranges from 26% to 67% for tests and 18% to 48% for referrals. [2][3][4][5] Patient expectations clearly affect physician behavior. 6 Nonetheless, doctors do not always meet their patients' expectations, sometimes for good reason.…”

Section: Designmentioning

confidence: 99%

Older Patients Perceptions of “Unnecessary” Tests and Referrals

et al. 2008

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CONTEXT: Unnecessary exposure to medical interventions can harm patients. Many hope that generalist physicians can limit such unnecessary exposure.OBJECTIVE: To assess older Americans' perceptions of the need for tests and referrals that their personal physician deemed unnecessary. DESIGN:Telephone survey with mail follow-up in English and Spanish, conducted from May to September 2005 (overall response rate 62%).STUDY PARTICIPANTS: Nationally representative sample of 2,847 community-dwelling Medicare beneficiaries. Main analyses focus on the 2,319 who had a personal doctor ("one you would see for a check-up or advice if you were sick") whom they described as a generalist ("doctor who treats many different kinds of problems").MAIN OUTCOME MEASURE: Proportion of respondents wanting a test or referral that their generalist suggested was not necessary using 2 clinical vignettes (cough persisting 1 week after other flu symptoms; mild but definite chest pain lasting 1 week).RESULTS: Eighty-two percent of Medicare beneficiaries had a generalist physician; almost all (97%) saw their generalist at least once in the past year. Among those with a generalist, 79% believed that it is "better for a patient to have one general doctor who manages most of their medical problems" than to have each problem cared for by a specialist. Nevertheless, when faced with new symptoms, many would want tests and referrals that their doctor did not think necessary. For a cough persisting 1 week after flu symptoms, 34% would want to see a lung specialist even if their generalist told them they "probably did not need to see a specialist but could if they wanted to." For 1 week of mild but definite chest pain when walking up stairs, 55% would want to see a heart specialist even if their generalist did not think it necessary. In these same scenarios, even higher proportions would want diagnostic testing; 57% would want a chest x-ray for the cough, and 74% would want "special tests" for the chest pain.CONCLUSIONS: When faced with new symptoms, many older patients report that they would want a diagnostic test or specialty referral that their generalist thought was unnecessary. Generalists striving to provide patient-centered care while at the same time limiting exposure to unnecessary medical interventions will need to address their patients' perceptions regarding the need for these services.KEY WORDS: geriatrics; patient perceptions; tests and referrals; shared decision making.

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Why do patients want to have their blood tested? A qualitative study of patient expectations in general practice

Cited by 52 publications

References 16 publications

Birmingham and Lambeth Liver Evaluation Testing Strategies (BALLETS): a prospective cohort study

Birmingham and Lambeth Liver Evaluation Testing Strategies (BALLETS): a prospective cohort study

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

Older Patients Perceptions of “Unnecessary” Tests and Referrals

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