A Q-Probes Study Involving Utilization of Free Prostate-Specific Antigen, Factor V Leiden, and Hepatitis A Serology Tests

Abstract

Utilization review was infrequent for the 3 tests examined. Variable amounts of unnecessary testing were observed for all tests, most frequently for free PSA, for which reporting results carried the added risk of diagnostic error from misinterpretation of results.

Reflex Testing of Free Prostate-Specific Antigen as Effective Health Care Policy

“…To the Editor.-We read with interest the article by Schifman et al 1 dealing with the utilization of measurement of free prostate-specific antigen (fPSA). We would like to contribute by reporting our experience about the management of fPSA requests by using a reflex testing approach and briefly discuss the status of the analytic control of this measurement.…”

“…It was interesting to read that only about 16% of free PSA orders met guidelines, which was comparable to the proportion of cases (163 of 790, 20.6%), collectively that met similar testing criteria, among 28 Q-Probes participants. 1 Use of a reflex testing protocol in which total PSA is evaluated first as a prerequisite step to determine if free PSA is performed was a sound practice, which effectively eliminated most of the waste from unnecessary testing. Another potential benefit derived from reflex free PSA testing worth noting is prevention of diagnostic error by reducing risk that free PSA may be clinically misapplied if reported when total PSA is outside the interpretable range.…”