Laboratory services play an important role in screening, diagnosis, and management of patients. A survey of UK laboratories showed an 83% increase in requests for tests from primary care between 2000 and 2004. While there are many potential justified reasons for this rise, evidence suggests that unnecessary ordering of tests could also be contributing to the increase. Unnecessary tests waste resources and time, and could lead to unnecessary investigation and treatment of healthy individuals with false-positive results.
Bernie Croal (Aberdeen, UK) and colleagues developed two strategies to try and reduce the numbers of requests for a set of nine lab tests: a feedback booklet containing practice requesting rates plus educational messages and brief educational reminder messages to go on results reports. The investigators randomised 85 primary care practices (370 family practitioners) in Scotland, UK, that all request tests from one centre to receive none of the strategies, enhanced feedback alone, reminder messages alone, or both strategies. The investigators found that after a year, enhanced feedback and brief educational message reminders alone achieved a reduction of around 10% in the number of requests in total, and in combination, the strategies lead to a 22% reduction.
Dr Croal states: "Enhanced feedback of requesting rates and brief educational reminder messages, alone and in combination, are effective strategies for reducing unnecessary test requesting in primary care. Both strategies are feasible within most laboratory settings…To inform the use of these interventions in routine practice, the long-term effects on test requesting need to be rigorously assessed."
Contact: Dr Bernard Lewis Croal, Department of Clinical Biochemistry, NHS Grampian, Polwarth Building, Foresterhill, Aberdeen, UK. T) +44 (0) 1224 552507 firstname.lastname@example.org
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