Abstract
BackgroundImmediate blood testing for patients presenting with unexplained complaints in family practice is superfluous from a diagnostic point of view. However, many general pracitioners (GPs) order tests immediately. Watchful waiting reduces the number of patients to be tested and the number of false-positive results. The objectives of this study are: to determine the feasibility of watchful waiting compared to immediate test ordering; to determine if a special quality improvement strategy can improve this feasibility; and to determine if watchful waiting leads to testing at a later time.MethodsThe study is a cluster-randomized clinical trial with three groups, on blood test ordering strategies in patients with unexplained complaints. GPs in group one were instructed to order tests immediately and GPs in group two to apply a watchful waiting approach. GPs in group three received the same instruction as group two, but they were supported by a systematically designed quality improvement strategy. A total of 498 patients with unexplained complaints from 63 practices of Dutch GPs participated. We measured: the percentage of patients for whom tests were ordered and number of tests ordered at the first consultation; performance on the strategy's performance objectives (i.e., ordering fewer tests and specific communication skills); the number of tests ordered after four weeks; and GP and patient characteristics.ResultsImmediate test ordering proved feasible in 92% of the patients; watchful waiting in 86% and 84%, respectively, for groups two and three. The two watchful waiting groups did not differ significantly in the achievement of any of the performance objectives. Of the patients who returned after four weeks, none from group one and six from the two watchful waiting groups had tests ordered for them.ConclusionsWatchful waiting is a feasible approach. It does not lead to testing immediately afterwards. Furthermore, watchful waiting was not improved by the quality improvement strategy.Trial registrationClinical trial registration: ISRCTN55755886
Highlights
Immediate blood testing for patients presenting with unexplained complaints in family practice is superfluous from a diagnostic point of view
91 general pracitioners (GPs) were randomized in the study, nine of whom ended their cooperation before the inclusion started, mainly due to private circumstances and pressure of work, and 19 did not include any patients
Our findings show that watchful waiting is a feasible approach for patients presenting with unexplained complaints in general practice
Summary
Immediate blood testing for patients presenting with unexplained complaints in family practice is superfluous from a diagnostic point of view. Many general pracitioners (GPs) order tests immediately. Watchful waiting reduces the number of patients to be tested and the number of false-positive results. The objectives of this study are: to determine the feasibility of watchful waiting compared to immediate test ordering; to determine if a special quality improvement strategy can improve this feasibility; and to determine if watchful waiting leads to testing at a later time. GPs and patients are summarized in Tables 2 and 3. The mean age of the participating GPs was 45 years, and 74% of them were male. The mean number of years of experience was 13. The mean age of the patients was 43, and 28% were male. None of the differences between the randomization groups were statistically significant (p > 0.05)
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