Frequencies and patterns of laboratory test requests from general practice: a service evaluation to inform point-of-care testing

Fanshawe, Thomas R; Ordóñez‐Mena, José M.; Turner, P; Bruel, Ann Van den; Shine, Brian; Hayward, Gail

doi:10.1136/jclinpath-2018-205242

Cited by 4 publications

(5 citation statements)

References 27 publications

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“…Increases in testing are also likely to have knock-on effects to other aspects of healthcare, including the financial burden on the NHS, the time burden on general practitioners and laboratory workloads, potentially resulting in delayed or missed diagnosis 34. Reducing the amount of serum creatinine testing performed as part of kidney function monitoring could ease some of these burdens, although we acknowledge that a reasonable amount of serum creatinine testing is performed as part of test batches not directly related to the assessment of kidney function and including other tests such as full blood counts 35…”

Section: Discussionmentioning

confidence: 99%

Trends in kidney function testing in UK primary care since the introduction of the quality and outcomes framework: a retrospective cohort study using CPRD

et al. 2019

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ObjectivesTo characterise serum creatinine and urinary protein testing in UK general practices from 2005 to 2013 and to examine how the frequency of testing varies across demographic factors, with the presence of chronic conditions and with the prescribing of drugs for which kidney function monitoring is recommended.DesignRetrospective open cohort study.SettingRoutinely collected data from 630 UK general practices contributing to the Clinical Practice Research Datalink.Participants4 573 275 patients aged over 18 years registered at up-to-standard practices between 1 April 2005 and 31 March 2013. At study entry, no patients were kidney transplant donors or recipients, pregnant or on dialysis.Primary outcome measuresThe rate of serum creatinine and urinary protein testing per year and the percentage of patients with isolated and repeated testing per year.ResultsThe rate of serum creatinine testing increased linearly across all age groups. The rate of proteinuria testing increased sharply in the 2009–2010 financial year but only for patients aged 60 years or over. For patients with established chronic kidney disease (CKD), creatinine testing increased rapidly in 2006–2007 and 2007–2008, and proteinuria testing in 2009–2010, reflecting the introduction of Quality and Outcomes Framework indicators. In adjusted analyses, CKD Read codes were associated with up to a twofold increase in the rate of serum creatinine testing, while other chronic conditions and potentially nephrotoxic drugs were associated with up to a sixfold increase. Regional variation in serum creatinine testing reflected country boundaries.ConclusionsOver a nine-year period, there have been increases in the numbers of patients having kidney function tests annually and in the frequency of testing. Changes in the recommended management of CKD in primary care were the primary determinant, and increases persist even after controlling for demographic and patient-level factors. Future studies should address whether increased testing has led to better outcomes.

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Section: Discussionmentioning

confidence: 99%

Trends in kidney function testing in UK primary care since the introduction of the quality and outcomes framework: a retrospective cohort study using CPRD

et al. 2019

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“…Despite the potential advantages of POC testing in primary care, barriers to uptake include concerns about their clinical utility and technical performance, overreliance on results, undermining of clinical skills and cost. 16 Identifying which individual tests and combinations are most frequently requested from primary care, as has already been noted for biochemistry laboratory blood tests, 17 could inform test development and adoption of POC tests by general practitioners (GPs). Although microbiology testing in primary care in the UK has been examined in terms of regional inequalities for a limited number of tests, 18 a comprehensive assessment of current demand for microbiology testing from primary care is currently lacking.…”

Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

“…16 Comparison with other literature A previous study investigated the demand for biochemistry laboratory blood tests in the community in Oxfordshire. 17 In comparison, microbiology tests form a smaller number of overall requests from primary care (approximately 145 000 per year vs 3.6 million per year), but microbiology tests were more frequently repeated within 7 days (18% vs less than 3% for most specific blood tests). This might be explained by the number of urine cultures that returned inconclusive or mixed growth results.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Frequencies and patterns of microbiology test requests from primary care in Oxfordshire, UK, 2008–2018: a retrospective cohort study of electronic health records to inform point-of-care testing

et al. 2021

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ObjectivesTo inform point-of-care test (POCT) development, we quantified the primary care demand for laboratory microbiology tests by describing their frequencies overall, frequencies of positives, most common organisms identified, temporal trends in testing and patterns of cotesting on the same and subsequent dates.DesignRetrospective cohort study.SettingPrimary care practices in Oxfordshire.Participants393 905 patients (65% female; 49% aged 18–49).Primary and secondary outcome measuresThe frequencies of all microbiology tests requested between 2008 and 2018 were quantified. Patterns of cotesting were investigated with heat maps. All analyses were done overall, by sex and age categories.Results1 596 752 microbiology tests were requested. Urine culture±microscopy was the most common of all tests (n=673 612, 42%), was mainly requested without other tests and was the most common test requested in follow-up within 7 and 14 days. Of all urine cultures, 180 047 (27%) were positive and 172 651 (26%) showed mixed growth, and Escherichia coli was the most prevalent organism (132 277, 73% of positive urine cultures). Antenatal urine cultures and blood tests in pregnancy (hepatitis B, HIV and syphilis) formed a common test combination, consistent with their use in antenatal screening.ConclusionsThe greatest burden of microbiology testing in primary care is attributable to urine culture ± microscopy; genital and routine antenatal urine and blood testing are also significant contributors. Further research should focus on the feasibility and impact of POCTs for these specimen types.

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“…32 GPs commonly request blood test combinations that check for abnormal inflammation in patients such as C-reactive protein (CRP), full blood count, glycated haemoglobin, ferritin and/or neutrophil count. 33,34 Their usefulness as surrogate endpoints has been confirmed in clinical trials in multiple cancer types. 35 Improvements to the home built environment (H-BE) lead to better health.…”

Section: Introductionmentioning

confidence: 99%

Home-built environment interventions and inflammation biomarkers: a systematic review and meta-analysis protocol

et al. 2022

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BackgroundInflammation control is a fundamental part of chronic care in patients with a history of cancer and comorbidity. As the risk-benefit profile of anti-inflammatory drugs in cancer survivors (CS) is unclear, GPs and patients could benefit from alternative non-pharmacological treatment options for dysregulated inflammation. There is a potential for home built environment (H-BE) interventions to modulate inflammation, however, discrepancies exist between studies.AimTo evaluate the effectiveness of H-BE interventions on cancer-associated inflammation biomarkers.Design & settingA systematic review and meta-analysis of randomised and non-randomised trials in community-dwelling adults.MethodPubMed-Medline, Embase, Web of Science, and Google Scholar will be searched for clinical trials published in January 2000 onwards. We will include H-BE interventions modifying air quality, thermal comfort, non-ionising radiation, noise, nature and water. No restrictions to study population will be applied to allow deriving expectations for effects of the interventions in CS from available source populations. Outcome measures will be inflammatory biomarkers clinically and physiologically relevant to cancer. The first reviewer will independently screen articles together with GPs and extract data that will be verified by a second reviewer. The quality of studies will be assessed using the Cochrane Risk-of-Bias tools. Depending on the clinical and methodological homogeneity of populations, interventions, and outcomes, we will conduct a meta-analysis using random-effects models.ConclusionsFindings will determine the effectiveness of H-BE interventions on inflammatory parameters, guide future directions for its provision in community-dwelling CS and support GPs with safer anti-inflammatory treatment options in high-risk patients for clinical complications.

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Frequencies and patterns of laboratory test requests from general practice: a service evaluation to inform point-of-care testing

Abstract: The current high volume of single and combination test requests highlights an opportunity for reliable multiplex point-of-care panels to cover a core set of frequently requested tests. The impact on test use of introducing such panels to general practice requires additional research.

Cited by 4 publications

References 27 publications

Trends in kidney function testing in UK primary care since the introduction of the quality and outcomes framework: a retrospective cohort study using CPRD

Trends in kidney function testing in UK primary care since the introduction of the quality and outcomes framework: a retrospective cohort study using CPRD

Frequencies and patterns of microbiology test requests from primary care in Oxfordshire, UK, 2008–2018: a retrospective cohort study of electronic health records to inform point-of-care testing

Home-built environment interventions and inflammation biomarkers: a systematic review and meta-analysis protocol

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