Preventing overuse of laboratory diagnostics: a case study into diagnosing anaemia in Dutch general practice

Abstract

Background: More information is often thought to improve medical decision-making, which may lead to test overuse. This study assesses which out of 15 laboratory tests contribute to diagnosing the underlying cause of anaemia by general practitioners (GPs) and determines a potentially more efficient subset of tests for setting the correct diagnosis. Methods: Logistic regression was performed to determine the impact of individual tests on the (correct) diagnosis. The statistically optimal test subset for diagnosing a (correct) underlying cause of anaemia by GPs was determined using data from a previous survey including cases of real-world anaemia patients. Results: Only 9 (60%) of the laboratory tests, and patient age, contributed significantly to the GPs' ability to diagnose an underlying cause of anaemia (CRP, ESR, ferritin, folic acid, haemoglobin, leukocytes, eGFR/MDRD, reticulocytes and serum iron). Diagnosing the correct underlying cause may require just five (33%) tests (CRP, ferritin, folic acid, MCV and transferrin), and patient age. Conclusions: In diagnosing the underlying cause of anaemia a subset of five tests has most added value. The realworld impact of using only this subset should be further investigated. As illustrated in this case study, a statistical approach to assessing the added value of tests may reduce test overuse.

The effectiveness of an automated algorithm as a tool for investigating the cause of anaemia in undiagnosed patients from general practitioners

“…[8][9][10][11] General practitioners may therefore benefit from added guidance from laboratory diagnostics to reveal the cause of anaemia. 10,12 To overcome missing causes of anaemia and supporting correct testing strategy, an automated algorithm was developed by Atalmedial in 2020 that supports the GP in finding the cause of anaemia according to the DCGP guidelines. The subsequent steps of the DCGP anaemia guideline were programmed in a Clinical Decision Support (CDS) software further called CDS-anaemia.…”

“…Otherwise overutilization of diagnostic blood tests might occur, but also underutilization in anaemic patients with the risk of incomplete or missing diagnosis and potentially leading to increased healthcare costs. [8][9][10][11] General practitioners may therefore benefit from added guidance from laboratory diagnostics to reveal the cause of anaemia. 10,12 To overcome missing causes of anaemia and supporting correct testing strategy, an automated algorithm was developed by Atalmedial in 2020 that supports the GP in finding the cause of anaemia according to the DCGP guidelines.…”