Abstract
BackgroundSystematic reviews have shown that, although well prepared, the Consensus Guidelines have failed to change clinical practice. In the healthcare district of Castelnovo né Monti (Reggio Emilia, Italy), it became necessary for the GPs and Clinical Pathologists to work together to jointly define laboratory profiles.MethodsObservational study with two cycles of retrospective audit on test request forms, in a primary care setting. Objectives of the study were to develop pathology-specific laboratory profiles and to increase the number of provisional diagnoses on laboratory test request forms. A Multiprofessional Multidisciplinary Inter-hospital Work Team developed pathology-specific laboratory profiles for more effective test requesting. After 8 training sessions that used a combined strategy with multifaceted interventions, the 23 General Practitioners (GPs) in the trial district (Castelnovo nè Monti) tested the profiles; the 21 GPs in the Puianello district were the control group; all GPs in both districts participated in the trial. All laboratory tests for both healthcare districts are performed at the Laboratory located in the trial district. A baseline and a 1-year audit were performed in both districts on the GPs’ request forms.ResultsSeven pathology-specific laboratory profiles for outpatients were developed. In the year after the first audit cycle: 1) the number of tests requested in the trial district was distinctly lower than that in the previous year, with a decrease of about 5% (p < 0.001); 2) the provisional diagnosis on the request forms was 52.8% in the trial district and 42% in the control district (P < 0.001); 3) the decrease of the number of tests on each request form was much more marked in the trial district (8.73 vs. 10.77; p < 0.001).ConclusionsThe first audit cycle showed a significant decrease in the number of tests ordered only in the trial district. The combined strategy used in this study improved the prescriptive compliance of most of the GPs involved. The presence of the clinical pathologist is seen as an added value.
Highlights
Systematic reviews have shown that, well prepared, the Consensus Guidelines have failed to change clinical practice
In 1995, McDonald and Smith stated that the clinical pathologist “must add value and medical relevance to the healthcare system to earn and maintain” an important role
In Italy, General Practitioners (GPs) are directly responsible for prescribing outpatient laboratory tests
Summary
Systematic reviews have shown that, well prepared, the Consensus Guidelines have failed to change clinical practice. In the healthcare district of Castelnovo né Monti (Reggio Emilia, Italy), it became necessary for the GPs and Clinical Pathologists to work together to jointly define laboratory profiles. [1] As the last 20 years have witnessed an enormous increase in laboratory medicine know-how and technology and the use of practical guidelines and Compliance with the guidelines does not automatically translate into appropriate patient care, . While not considered useful for solving complex clinical problems, algorithms or, in our case, pathology-specific laboratory profiles are simpler than clinical guidelines as tools for guiding individual actions or decisions. Thanks to their simplicity they can be incorporated in computerized programs and produced in the form of flowcharts. 30% of the outpatient laboratory tests are ordered without a definite working diagnosis; in these cases they are ordered, for example, “just to check,””to reassure my patients,” “because lab tests should be done at least once a year,” “for prevention,” and so on [6,7,8]
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