Rates of inappropriate laboratory test utilization in Ontario
Section snippets
Background
Appropriate utilization of resources is required to ensure that health care remains sustainable and to promote the best outcomes for patients [1]. While diagnostic test utilization has long been an important issue [2], [3], [4], health care systems increasingly face challenges related to aging populations, the rapid introduction of new technology and changing educational environments for healthcare providers. Initiatives such as Choosing Wisely are highlighting relevant issues [5]. Recent
Methods
We study one clearly defined category of excessive laboratory utilization where inappropriate is defined solely in terms of the time interval between tests. The analytes selected for consideration are thyroid stimulating hormone (TSH), hemoglobin A1c (HbA1c), lipid profile, serum protein electrophoresis (SPEP), immunofixation (IFE), quantitative immunoglobulins (QI), Vitamin D, Vitamin B12, and folate. These are selected as they have generally accepted guidelines on the appropriate frequency of
Results
In Table 2 we report: the number of laboratory tests done in the province for each of the analytes listed above, tests per capita where the denominator is the population of Ontario obtained from Statistics Canada (2016, CANSIM Table 051-0001), the number and percentage of inappropriately ordered laboratory tests, the number of patients who had the test, the percentage of patients who had at least one inappropriately ordered test, and the percentage of patients with more than one inappropriately
Discussion
This study demonstrates that a large proportion of physicians (Table 3) make inappropriate orders. The widespread inconsistency with best practice guidelines highlights that some form of support is required to facilitate appropriate ordering. Similarly, a study done in Alberta finds that 16% of six laboratory tests are repeated earlier than necessary [20]. Another study from the Veterans' Administration (VA) health system in the United States found that 30% of patients being followed for
Conclusions
Relatively large proportions of the tests ordered for the nine analytes studied are inappropriate according to accepted best practice guidelines. These tests are mostly ordered by the same physician, and both primary care and speciality physicians exhibit this inappropriate testing practice. Most inappropriate repeats occur only once in the defined time frame, but multiple repeat tests are also quite common. This study demonstrates that there are areas for improvement in the ordering of medical
Acknowledgements
This research was funded by the Government of Ontario (02045). The views expressed in this paper are the views of the authors and should not be taken to represent the views of the Government of Ontario.
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