Canadian family physician knowledge and attitudes toward laboratory utilization management

Thommasen, Amy; Clement, Fiona; Kinniburgh, David; Lau, Cecilia; Guo, Maggie; Viczko, Jeannine; Guggisberg, Kelly; Turin, Tanvir Chowdhury; Wesenberg, James C.; Abdullah, Amid; Hnydyk, William S.; Naugler, Christopher

doi:10.1016/j.clinbiochem.2015.09.010

Cited by 11 publications

(5 citation statements)

References 8 publications

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“…4,5 We anticipated that there may have been more questions or concerns given that a recent survey of Alberta primary care physicians showed that specialized test requisitions for certain tests were felt to be acceptable to only 45% of survey respondents. 17 In the current era of unsustainable increases in laboratory test volumes in Canada, 18,19 the managed exit of low-value tests is needed to ensure resources are available for medically necessary tests. To our knowledge, Alberta is the only jurisdiction to have implemented a policy such as this.…”

Section: Discussionmentioning

confidence: 99%

Implementation of an intervention to reduce population-based screening for vitamin D deficiency: a cross-sectional study

et al. 2017

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Background:We describe the implementation of an intervention in Alberta in support of the Choosing Wisely Canada recommendation against population screening for vitamin D deficiency (as determined by serum total 25-hydroxyvitamin D testing). We hypothesized that the introduction of a specialized requisition for vitamin D testing would reduce the annual number of vitamin D tests performed. Methods:We performed a cross-sectional observational study that included all vitamin D tests ordered in Alberta between Apr. 1, 2015, and Mar. 31, 2016. There were no exclusion criteria. A special requisition for ordering vitamin D tests in Alberta was introduced on Apr. 1, 2015. Using an interrupted time series model, we compared predicted versus observed vitamin D test volumes for the 12-month period following the introduction of the new requisition. The sole outcome measure was the monthly change in volume of vitamin D testing. In addition, we calculated any cost savings as a result of reduced testing. Results:Over the first 12 months of the intervention, there was a reduction in the number of tests ordered from a predicted 342 477 tests to 29 525 tests (91.4% reduction). This decrease represented a direct spending decrease of Can$938 856-$1 564 760 per year in Alberta.Interpretation: A provincially led implementation of a Choosing Wisely Canada recommendation resulted in a large and sustained reduction in serum total 25-hydroxyvitamin D testing in Alberta. This study shows that provincially led interventions based on Choosing Wisely Canada recommendations can result in substantial reductions in laboratory tests.Vitamin D screening has been particularly problematic for the health system in Alberta because there has been a massive increase in test volumes over the past 10 years, 9 with evidence that testing has been preferentially directed toward low-risk patients. 10 We describe the implementation of an intervention in Alberta in support of the Choosing Wisely Canada recommendation against population screening for vitamin D deficiency. This initiative was accompanied by a province-wide communication strategy that included an update of the provincial clinical practice guidelines to align them with the new requisition, development of an information sheet that was provided to physicians to give to patients who requested vitamin D testing that was not clinically indicated, and the appending of a comment describing the intervention to all reported vitamin D results for the month before the intervention. Methods Intervention SettingThis work was performed in Alberta and includes all vitamin D tests ordered in the province from Apr. 1, 20151, , to Mar. 31, 2016. This is an observational study using publicly available secondary data on laboratory test volumes. The intervention exposure was equal for all physicians (a specialized requisition) and there were not treatment and control groups. There was no specific follow-up of either patients or physicians in this study. Test volumes for both inpatient and outpatient samples were us...

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Section: Discussionmentioning

confidence: 99%

Implementation of an intervention to reduce population-based screening for vitamin D deficiency: a cross-sectional study

et al. 2017

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“…There is a trade-off between the effectiveness of utilization management interventions and their acceptability to end-users. For example, a recent survey of family physicians showed that nearly all (98 percent) were accepting of educational utilization management interventions (Thommasen et al 2016). However, a high-quality randomized controlled trial of such education showed no effect on utilization (Thomas et al 2016).…”

Section: The Trade-off Between Effectiveness and Acceptabilitymentioning

confidence: 99%

“…Likewise, audit and feedback interventions are acceptable to 85 percent of family physicians (Thommasen et al 2016) but produce only modest changes in utilization (Thomas et al 2016). Evidence suggests that physicians' beliefs about appropriate levels of testing are correlated with ordering practices suggesting that those who order more tests than average may be self-aware of their variation from their peers, even without audit and feedback mechanisms (Epstein and McNeil 1986).…”

Section: The Trade-off Between Effectiveness and Acceptabilitymentioning

confidence: 99%

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What the Doctor Ordered: Improving the Use and Value of Laboratory Testing

Naugler

Wyonch²

2019

SSRN Journal

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The C.D. Howe Institute's reputation for quality, integrity and nonpartisanship is its chief asset. Its books, Commentaries and E-Briefs undergo a rigorous two-stage review by internal staff, and by outside academics and independent experts. The Institute publishes only studies that meet its standards for analytical soundness, factual accuracy and policy relevance. It subjects its review and publication process to an annual audit by external experts. As a registered Canadian charity, the C.D. Howe Institute accepts donations to further its mission from individuals, private and public organizations, and charitable foundations. It accepts no donation that stipulates a predetermined result or otherwise inhibits the independence of its staff and authors. The Institute requires that its authors disclose any actual or potential conflicts of interest of which they are aware. Institute staff members are subject to a strict conflict of interest policy. C.D. Howe Institute staff and authors provide policy research and commentary on a non-exclusive basis. No Institute publication or statement will endorse any political party, elected official or candidate for elected office. The views expressed are those of the author(s). The Institute does not take corporate positions on policy matters.

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“…5,6 Despite the unpleasant impact caused by laboratory tests, studies revealed 26.4% and 20.6% of all laboratory tests are over utilised. 7,8 It is both clinically and fi nancially signifi cant to understand physician ordering behaviour in requesting laboratory tests. Recognising over utilised laboratory tests and developing strategies to improve physician ordering behaviour in requesting diagnostic tests in the form of utilisation review programmes and behavioural change are considered priorities in health systems in every country, particularly developing countries.…”

Section: Introductionmentioning

confidence: 99%

Going beyond Audit and Feedback: Towards Behaviour-Based Interventions to Change Physician Laboratory Test Ordering Behaviour

Meidani

Ga²,

Kheirkhah

et al. 2017

Journal of the Royal College of Physicians of Edinburgh

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Studies indicate there are a variety of contributing factors affecting physician test ordering behaviour. Identifying these behaviours allows development of behaviour-based interventions.Methods Through a pilot study, the list of contributing factors in laboratory tests ordering, and the most ordered tests, were identi ed, and given to 50 medical students, interns, residents and paediatricians in questionnaire form. The results showed routine tests and peer or supervisor pressure as the most in uential factors affecting physician ordering behaviour. An audit and feedback mechanism was selected as an appropriate intervention to improve physician ordering behaviour. The intervention was carried out at two intervals over a three-month period.Findings There was a large reduction in the number of laboratory tests ordered; from 908 before intervention to 389 and 361 after rst and second intervention, respectively. There was a signi cant relationship between audit and feedback and the meaningful reduction of 7 out of 15 laboratory tests including complete blood count (p = 0.002), erythrocyte sedimentation rate (p = 0.01), C-reactive protein (p = 0.01), venous blood gas (p = 0.016), urine analysis (p = 0.005), blood culture (p = 0.045) and stool examination (p = 0.001).Conclusion The audit and feedback intervention, even in short duration, affects physician ordering behaviour. It should be designed in terms of behaviour-based intervention and diagnosis of the contributing factors in physicians' behaviour. Further studies are required to substantiate the effectiveness of such behaviour-based intervention strategies in changing physician behaviour.Keywords: audit and feedback, child, diagnostic tests, laboratory medicine, medical students, physicians, teaching rounds, test ordering, test request, utilisation review Declaration of interests: No confl ict of interests declaredAbstract Introduction

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Canadian family physician knowledge and attitudes toward laboratory utilization management

Cited by 11 publications

References 8 publications

Implementation of an intervention to reduce population-based screening for vitamin D deficiency: a cross-sectional study

Implementation of an intervention to reduce population-based screening for vitamin D deficiency: a cross-sectional study

What the Doctor Ordered: Improving the Use and Value of Laboratory Testing

Going beyond Audit and Feedback: Towards Behaviour-Based Interventions to Change Physician Laboratory Test Ordering Behaviour

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