Abstract
BackgroundMore 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.MethodsLogistic 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.ResultsOnly 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.ConclusionsIn diagnosing the underlying cause of anaemia a subset of five tests has most added value. The real-world 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.
Highlights
More information is often thought to improve medical decision-making, which may lead to test overuse
Oonk contributed to this work. 1Department of Health Technology and Services Research, University of Twente, Technical Medical Center, Faculty of Behavioural, Management and Social Sciences, Enschede, the Netherlands Full list of author information is available at the end of the article. This issue is relevant for general practitioners (GPs) as they order a large variety of laboratory tests during ~ 30% of all patient encounters [3, 4]. These challenges are partly unavoidable owing to the large variability of symptoms encountered within general practices [6], GPs may benefit from improved guidance as to which tests to order in which patients
As it was considered unlikely that other, less common, causes of anaemia can be diagnosed in general practice [31], this study focused on correctly diagnosing iron deficiency anaemia (IDA), anaemia of chronic disease (ACD) and renal anaemia (RA)
Summary
More information is often thought to improve medical decision-making, which may lead to test overuse. In the last decades there has been a strong rise in the number of relatively cheap laboratory tests that are available as well as in the number of tests requested by physicians [1, 2] These developments provide challenges to physicians with regard to determining which tests to order and how to interpret their combined results [3,4,5]. This issue is relevant for general practitioners (GPs) as they order a large variety of laboratory tests during ~ 30% of all patient encounters [3, 4].
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