Trends and Between-Physician Variation in Laboratory Testing: A Retrospective Longitudinal Study in General Practice

Journal of Clinical Medicine

Yael Rachamin¹  Levy Jäger¹  LisaD. Schumacher¹  Oliver Senn¹  Stefan Markun¹  Rahel Meier¹  Thomas Rosemann¹ 

[1] Institute of Primary Care, University and University Hospital Zurich, 8091 Zurich, Switzerland;

关键词: laboratory testing;    trend;    general practice;    mixed-effect model;    intraclass correlation coefficient;   

DOI  :  10.3390/jcm9061787

来源: DOAJ

【 摘 要 】

Laboratory tests are frequently ordered by general practitioners (GPs), but little is known about time trends and between-GP variation of their use. In this retrospective longitudinal study, we analyzed over six million consultations by Swiss GPs during the decade 2009–2018. For 15 commonly used test types, we defined specific laboratory testing rates (sLTR) as the percentage of consultations involving corresponding laboratory testing requests. Patient age- and sex-adjusted time trends of sLTR were modeled with mixed-effect logistic regression accounting for clustering of patients within GPs. We quantified between-GP variation by means of intraclass correlation coefficients (ICC). Nine out of the 15 laboratory test types considered showed significant temporal increases, most eminently vitamin D (ten-year odds ratio (OR) 1.88, 95% confidence interval (CI) 1.71–2.06) and glycated hemoglobin (ten-year OR 1.87, 95% CI 1.82–1.92). Test types both subject to substantial increase and high between-GP variation of sLTR were vitamin D (ICC 0.075), glycated hemoglobin (ICC 0.101), C-reactive protein (ICC 0.202), and vitamin B12 (ICC 0.166). Increasing testing frequencies and large between-GP variation of specific test type use pointed at inconsistencies of medical practice and potential overuse.

【 授权许可】

Unknown