Abstract
BackgroundRedundant use of diagnostic tests in primary care has shown to be a contributor to rising Dutch healthcare costs. A price display in the test ordering system of the electronic health records (EHRs) could potentially be a low-cost and easy to implement intervention to a decrease in test ordering rate in the primary care setting by creating more cost-awareness among general practitioners (GPs). The aim of this study was to assess the effect of a price display for diagnostic laboratory tests in the EHR on laboratory test ordering behavior of GPs in the Westelijke Mijnstreek region in the Netherlands.MethodsA pre-post intervention study among 154 GPs working in 57 general practices was conducted from September 2019, until March 2020, in the Netherlands. The intervention consisted of displaying the costs of 22 laboratory tests at the time of ordering. The primary outcome was the mean test ordering rate per 1.000 patients per month, per general practice.ResultsTest ordering rates were on average rising prior to the intervention. The total mean monthly test order volume showed a non-statistically significant interruption in this rising trend after the intervention, with the mean monthly test ordering rate levelling out from 322.4 to 322.2 (P = 0.86). A subgroup analysis for solely individually priced tests showed a statistically significant decrease in mean monthly test ordering rate after implementation of the price display for the sum of all tests from 67.2 to 63.3 (P = 0.01), as well as for some of these tests individually (i.e. thrombocytes, ALAT, TSH, folic acid). Leucocytes, ESR, vitamin B12, anti-CCP and NT-proBNP also showed a decrease, albeit not statistically significant (P > 0.05).ConclusionsOur study suggests that a price display intervention is a simple tool that can alter physicians order behavior and constrain the expanding use of laboratory tests. Future research might consider alternative study designs and a longer follow-up period. Furthermore, in future studies, the combination with a multitude of interventions, like educational programs and feedback strategies, should be studied, while potentially adverse events caused by reduced testing should also be taken into consideration.
Highlights
Redundant use of diagnostic tests in primary care has shown to be a contributor to rising Dutch healthcare costs
From 2012, health insurers in the Netherlands introduced a budget ceiling for laboratory testing diagnostics. Due to this budget ceiling for laboratory testing diagnostics, Medical Coordinating Center (MCC) Omnes was forced to reduce costs or laboratory test ordering from general practitioners (GPs)
With a rising trend in test ordering rate prior to the price display intervention, we found a noticeable interruption in this rising trend after the implementation of the price display, albeit not statistically significant
Summary
Redundant use of diagnostic tests in primary care has shown to be a contributor to rising Dutch healthcare costs. Healthcare expenditures in the Netherlands have shown an expansive growth in recent years. Despite being an indispensable part of medical practice, about 20–30% of diagnostic tests have shown to be of limited clinical value, contributing to the redundant growth of Dutch healthcare expenditures [3,4,5,6,7,8]. Diagnostic testing has become an attractive target for intervention to reduce future healthcare costs in the Netherlands, with the aim of preserving a long-term accessible and affordable Dutch health care system [3,4,5,6,7,8,9]
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