Long‐term effects of an education programme on the optimal use of clinical chemistry testing in primary health care

Objective: The aim of this study was to investigate whether continuing education on the optimal use of clinical chemistry testing in primary health care has had any long‐term effects on the test‐ordering behaviour of the participating physicians. Methods: The effects were monitored using 12 laboratory test ratios. Twenty‐three general practitioners at 16 primary health‐care centres in the county of Uppsala, Sweden, participated. A sign test was used to evaluate how individual physicians' test‐ordering patterns have changed during the 8 years since implementation of the educational programme. Maintained or improved ratios were interpreted as a sustained effect on the primary health‐care physician's test‐ordering habits. Results: Eleven out of 12 of the investigated ratios were the same or improved since the time of the short‐term follow‐up 6 months after the education. Conclusion: A short continuation course on optimal use of clinical chemistry assays can achieve permanent changes in the test‐ordering patterns of primary health‐care physicians. These findings highlight education as one possible means towards achieving cost‐efficiency and quality in test‐ordering.

[1]  Peter Davis,et al.  How much variation in clinical activity is there between general practitioners? A multi-level analysis of decision-making in primary care , 2002, Journal of health services research & policy.

[2]  J I Westbrook,et al.  Computerised pathology test order entry reduces laboratory turnaround times and influences tests ordered by hospital clinicians: a controlled before and after study , 2006, Journal of Clinical Pathology.

[3]  S. Miyakis,et al.  Factors contributing to inappropriate ordering of tests in an academic medical department and the effect of an educational feedback strategy , 2006, Postgraduate Medical Journal.

[4]  A D Oxman,et al.  Audit and feedback: effects on professional practice and health care outcomes. , 2000, The Cochrane database of systematic reviews.

[5]  J De Maeseneer,et al.  Use of blood tests in general practice: a collaborative study in eight European countries. Eurosentinel Study Group. , 1995, The British journal of general practice : the journal of the Royal College of General Practitioners.

[6]  N. Tryding,et al.  Effects of an education programme to change clinical laboratory testing habits in primary care. , 1999, Scandinavian journal of primary health care.

[7]  Todd Dorman,et al.  Effectiveness of continuing medical education. , 2007, Evidence report/technology assessment.

[8]  A. Lyon,et al.  Strategies to promote rational clinical chemistry test utilization. , 1996, Clinical biochemistry.

[9]  J. Eisenberg,et al.  An educational program to modify laboratory use by house staff. , 1977, Journal of medical education.

[10]  G. Lundberg,et al.  How clinicians should use the diagnostic laboratory in a changing medical world. , 1999, Clinica chimica acta; international journal of clinical chemistry.

[11]  G. Dinant,et al.  Rational, cost effective use of investigations in clinical practice , 2002, BMJ : British Medical Journal.

[12]  Trudy van der Weijden,et al.  Understanding laboratory testing in diagnostic uncertainty: a qualitative study in general practice. , 2002, The British journal of general practice : the journal of the Royal College of General Practitioners.

[13]  Factors predicting differences among general practitioners in test ordering behaviour and in the response to feedback on test requests. , 1996, Family practice.

[14]  P. Hjortdahl,et al.  The general practitioner and laboratory utilization: why does it vary? , 1992, Family practice.

[15]  R. Winkens,et al.  Variation in test ordering behaviour of GPs: professional or context-related factors? , 2004, Family practice.

[16]  E. Benson,et al.  The responsible use of the clinical laboratory. , 1986, Clinical biochemistry.

[17]  An assessment of utilisation, perceptions and impact on patient care , 1991 .

[18]  Dry chemistry pathology in general practice. An assessment of utilisation, perceptions and impact on patient care. Non-Laboratory Pathology Working Party of the National Health Technology Advisory Panel. , 1991, The Medical journal of Australia.

[19]  P Axt-Adam,et al.  Influencing Behavior of Physicians Ordering Laboratory Tests: A Literature Study , 1993, Medical care.

[20]  A D Oxman,et al.  Changing physician performance. A systematic review of the effect of continuing medical education strategies. , 1995, JAMA.

[21]  Jostein Grytten,et al.  Practice variation and physician-specific effects. , 2003, Journal of health economics.

[22]  C. Naylor,et al.  Do we know what inappropriate laboratory utilization is? A systematic review of laboratory clinical audits. , 1998, JAMA.

[23]  M. Crook,et al.  Pathology tests: is the time for demand management ripe at last? , 2003, Journal of clinical pathology.

[24]  M H Liang,et al.  Techniques to improve physicians' use of diagnostic tests: a new conceptual framework. , 1998, JAMA.

[25]  J. Knottnerus,et al.  Fitting a routine health-care activity into a randomized trial: an experiment possible without informed consent? , 1997, Journal of clinical epidemiology.

[26]  J A Knottnerus,et al.  Effects of routine individual feedback over nine years on general practitioners' requests for tests , 1996, BMJ.

[27]  W S A Smellie,et al.  Is clinical practice variability the major reason for differences in pathology requesting patterns in general practice? , 2002, Journal of clinical pathology.