Prevalence and associations of general practitioners’ ordering of “non-symptomatic” prostate-specific antigen tests: A cross-sectional analysis

Magin, Parker; Tapley, Amanda; Davey, Andrew; Morgan, Simon; Henderson, Kim; Holliday, Elizabeth G.; Ball, Jean; Catzikiris, Nigel; Mulquiney, Katie; Spike, Neil; Kerr, Rohan; Driel, Mieke van

doi:10.1111/ijcp.12998

Cited by 3 publications

(2 citation statements)

References 37 publications

(49 reference statements)

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“…Exploratory analyses allow us to establish associations of a wide range of registrar clinical exposures-for example, patient demographics (older patients [40], Aboriginal and Torres Strait Islander patients) [42] and problems/ diagnoses (for example, atopic dermatitis [43], post-natal care [44], vertigo [45]); and registrar actions (prescribing [46], deprescribing [47], delayed prescribing [48], test-ordering [49], referral [50], and preventive activities [51]). We can also examine the associations of structural aspects of the training experience.…”

Section: Exploratory Analysesmentioning

confidence: 99%

The Registrar Clinical Encounters in Training (ReCEnT) cohort study: updated protocol

et al. 2022

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Background During vocational general practice training, the content of each trainee’s (in Australia, registrars’) in-consultation clinical experience is expected to entail a breadth of conditions that exemplify general practice, enabling registrars to gain competency in managing common clinical conditions and common clinical scenarios. Prior to the Registrar Clinical Encounters in Training (ReCEnT) project there was little research into the content of registrars’ consultations despite its importance to quality of training. ReCEnT aims to document the consultation-based clinical and educational experiences of individual Australian registrars. Methods ReCEnT is an inception cohort study. It is comprised of closely interrelated research and educational components. Registrars are recruited by participating general practice regional training organisations. They provide demographic information about themselves, their skills, and their previous training. In each of three 6-month long general practice training terms they provide data about the practice where they work and collect data from 60 consecutive patient encounters using an online portal. Analysis of data uses standard techniques including linear and logistic regression modelling. The ReCEnT project has approval from the University of Newcastle Human Research Ethics Committee, Reference H-2009–0323. Discussion Strengths of the study are the granular detail of clinical practice relating to patient demographics, presenting problems/diagnoses, medication decisions, investigations requested, referrals made, procedures undertaken, follow-up arranged, learning goals generated, and in-consultation help sought; the linking of the above variables to the presenting problems/diagnoses to which they pertain; and a very high response rate. The study is limited by not having information regarding severity of illness, medical history of the patient, full medication regimens, or patient compliance to clinical decisions made at the consultation. Data is analysed using standard techniques to answer research questions that can be categorised as: mapping analyses of clinical exposure; exploratory analyses of associations of clinical exposure; mapping and exploratory analyses of educational actions; mapping and exploratory analyses of other outcomes; longitudinal ‘within-registrar’ analyses; longitudinal ‘within-program’ analyses; testing efficacy of educational interventions; and analyses of ReCEnT data together with data from other sources. The study enables identification of training needs and translation of subsequent evidence-based educational innovations into specialist training of general practitioners.

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Section: Exploratory Analysesmentioning

confidence: 99%

The Registrar Clinical Encounters in Training (ReCEnT) cohort study: updated protocol

et al. 2022

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“…Indeed, the Royal Australian College of General Practitioners (RACGP) does not recommend PSA screening of most asymptomatic men of any age 3 . Some testing might be justified (for example, screening of men at high risk, or prostate disease monitoring), but when Australian general practitioner registrars were asked to record specific reasons for ordering PSA tests, “asymptomatic screening” accounted for three‐quarters of requests 4 …”

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confidence: 99%

Excessive PSA testing in general practice

Coleman

2021

Medical Journal of Australia

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‘Low-value’ clinical care in general practice: a cross-sectional analysis of low-value care in early-career GPs’ practice

Ralston,

Fielding,

Holliday

et al. 2023

International Journal for Quality in Health Care

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Background Non-evidence-based and ‘low value’ clinical care and medical services are ‘questionable’ clinical activities that are more likely to cause harm than good or whose benefit is disproportionately low compared with its cost. This study sought to establish general practitioner (GP), patient, practice, and in-consultation associations of an index of key non-evidence-based or low-value ‘questionable’ clinical practices. Methods The study was nested in the Registrar Clinical Encounters in Training (ReCEnT) study - an ongoing (from 2010) cohort study in which Australian GP registrars (specialist GP trainees) record details of their in-consultation clinical and educational practice 6-monthly. The outcome factor in analyses, performed on ReCEnT data from 2010 to 2020, was score on the Questionable in-Training Clinical Activities Index (QUIT-CAI) which incorporates recommendations of the Australian Choosing Wisely campaign. A cross-sectional analysis used negative binomial regression (with the model including an offset for the number of times the registrar was at risk of performing a questionable activity) to establish associations of QUIT-CAI scores. Results 3,206 individual registrars (response rate 89.9%), recorded 406,812 problems/diagnoses where they were at risk of performing a questionable activity. Of these problems/diagnoses, 15,560 (3.8%) involved questionable activities being performed. In multivariable analyses, higher QUIT-CAI scores (more questionable activities) were significantly associated with earlier registrar training term: incidence rate ratio (IRR) 0.91 (95% CI 0.87, 0.95) and 0.85 (0.80, 0.90) for Term 2 and Term 3, respectively, compared to Term 1. Other significant associations of higher scores included the patient being new to the registrar (IRR 1.27; 95% CI 1.12-1.45), the patient being of non-English speaking background (IRR 1.24 [1.04, 1.47]), the practice being in a higher socioeconomic area decile (IRR 1.01; 1.00-1.02), small practice size (IRR 1.05; [1.00, 1.10]), shorter consultation duration (IRR 0.99 per minute [0.99, 1.00]), and fewer problems addressed in the consultation (IRR 0.84 [0.79-0.89] for each additional problem). Conclusion Senior registrars’ clinical practice entailed less ‘questionable’ clinical actions than junior registrars’ practice. The association of lower QUIT-CAI scores with a measure of greater continuity of care (the patient not being new to the registrar) suggests continuity should be supported and facilitated during GP training (and in established GPs’ practice).

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Prevalence and associations of general practitioners’ ordering of “non-symptomatic” prostate-specific antigen tests: A cross-sectional analysis

Abstract: GP registrars frequently order "asymptomatic" PSA tests. Our findings suggest that non-compliance with current guidelines for PSA screening may be relatively common and that targeted education is warranted.

Cited by 3 publications

References 37 publications

The Registrar Clinical Encounters in Training (ReCEnT) cohort study: updated protocol

The Registrar Clinical Encounters in Training (ReCEnT) cohort study: updated protocol

Excessive PSA testing in general practice

‘Low-value’ clinical care in general practice: a cross-sectional analysis of low-value care in early-career GPs’ practice

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