Best practice in primary care pathology: review 10

“…[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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“…Answers to the first 10 question and answer sets can be found in reviews 1–10 18 – 27. They have all used a common search methodology28 although where recent systematic reviews have been performed, the guidance relies heavily also on the findings of these reviews.…”

Section: Resultsmentioning

confidence: 99%

Best practice in primary care pathology: review 11

et al. 2007

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This eleventh best practice review examines two series of common primary care questions in laboratory medicine: (i) thyroid testing, and (ii) hypercalcaemia and hypocalcaemia. The review is presented in the same question–answer format as in the previous reviews. These questions and answers deal with common situations in men and non-pregnant women. The recommendations represent a précis of guidance found using a standardised literature search of national and international guidance notes, consensus statements, health policy documents and evidence-based medicine reviews, supplemented by Medline Embase searches to identify relevant primary research documents. In the case of the thyroid series, the recommendations are drawn from the 2006 guidelines published by the Association for Clinical Biochemistry, the British Thyroid Association and the British Thyroid Foundation. They are not standards but form a guide to be set in the clinical context. Most are consensus rather than evidence based. They will be updated periodically to take account of new information.

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Best practice in primary care pathology: review 10

Cited by 10 publications

References 46 publications

Time to harmonise common laboratory test profiles

Time to harmonise common laboratory test profiles

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

Best practice in primary care pathology: review 11

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