Abstract
BackgroundLaboratory testing is an integral part of day-to-day primary care practice, with approximately 30 % of patient encounters resulting in a request. However, research suggests that a large proportion of requests does not benefit patient care and is avoidable. The aim of this systematic review was to comprehensively search the literature for studies evaluating the effectiveness of interventions to improve primary care physician use of laboratory tests.MethodsA search of PubMed, Cochrane Library, Embase and Scopus (from inception to 09/02/14) was conducted. The following study designs were considered: systematic reviews, randomised controlled trials (RCTs), controlled clinical trials (CCTs), controlled before and after studies (CBAs) and interrupted time series analysis (ITSs). Studies were quality appraised using a modified version of the Effective Practice and Organisation of Care (EPOC) checklist. The population of interest was primary care physicians. Interventions were considered if they aimed to improve laboratory testing in primary care. The outcome of interest was a volume of laboratory tests.ResultsIn total, 6,166 titles and abstracts were reviewed, followed by 87 full texts. Of these, 11 papers were eligible for inclusion in the systematic review. This included four RCTs, six CBAs and one ITS study. The types of interventions examined included education, feedback, guidelines, education with feedback, feedback with guidelines and changing order forms. The quality of included studies varied with seven studies deemed to have a low risk of bias, three with unclear risk of bias and one with high risk of bias. All but one study found significant reductions in the volume of tests following the intervention, with effect sizes ranging from 1.2 to 60 %. Due to heterogeneity, meta-analysis was not performed.ConclusionsInterventions such as educational strategies, feedback and changing test order forms may improve the efficient use of laboratory tests in primary care; however, the level of evidence is quite low and the quality is poor. The reproducibility of findings from different laboratories is also difficult to ascertain from the literature. Some standardisation of both interventions and outcome measures is required to enable formal meta-analysis.Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-015-0356-4) contains supplementary material, which is available to authorized users.
Highlights
Laboratory testing is an integral part of day-to-day primary care practice, with approximately 30 % of patient encounters resulting in a request
Primary objective The main objective of this systematic review was to synthesise the available published literature on interventions focused on improving the appropriateness of laboratory requesting patterns from primary care
Our review suggests that many different interventions may change primary care physician requesting patterns, in particular multifaceted interventions
Summary
Laboratory testing is an integral part of day-to-day primary care practice, with approximately 30 % of patient encounters resulting in a request. The unnecessary use of laboratory services has been highlighted by a meta-analysis of 108 studies involving 1.6 million results from 46 of the 50 most commonly ordered lab tests in medicine [6]. This found that, on average, 30 % of all tests are likely to be unnecessary [6, 7]. With respect to primary care, US research has found that physicians order diagnostic laboratory tests for approximately 30 % of patient visits [8]. Authors reported that test-ordering factors including unnecessary test requests were responsible for 13 % of testing process errors in primary care [9]
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