Primary care use of laboratory tests in Northern Ireland’s Western Health and Social Care Trust: a cross-sectional study

Magda Bucholc, Maurice J. O'Kane, Ciaran Mullan, Siobhan Ashe, Liam Maguire

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Abstract

Objectives To describe the laboratory test ordering patterns by general practitioners (GPs) in Northern Ireland Western Health and Social Care Trust (WHSCT) and explore demographic and socioeconomic associations with test requesting. Design Cross-sectional study. Setting WHSCT, Northern Ireland. Participants 55 WHSCT primary care medical practices that remained open throughout the study period 1 April 2011-31 March 2016. Outcomes To identify the temporal patterns of laboratory test ordering behaviour for eight commonly requested clinical biochemistry tests/test groups in WHSCT. To analyse the extent of variations in laboratory test requests by GPs and to explore whether these variations can be accounted for by clinical outcomes or geographical, demographic and socioeconomic characteristics. Results The median number of adjusted test request rates over 5 consecutive years of the study period decreased by 45.7% for urine albumin/creatinine ratio (p<0.000001) and 19.4% for lipid profiles (p<0.000001) while a 60.6%, 36.6% and 29.5% increase was observed for HbA 1c (p<0.000001), immunoglobulins (p=0.000007) and prostate-specic antigen (PSA) (p=0.0003), respectively. The between-practice variation in test ordering rates increased by 272% for immunoglobulins (p=0.008) and 500% for HbA 1c (p=0.0001). No statistically significant relationship between ordering activity and either demographic (age and gender) and socioeconomic factors (deprivation) or Quality and Outcome Framework scores was observed. We found the rural-urban differences in between-practice variability in ordering rates for lipid profiles, thyroid profiles, PSA and immunoglobulins to be statistically significant at the Bonferroni-adjusted significance level p<0.01. Conclusions We explored potential factors of the interpractice variability in the use of laboratory tests and found that differences in requesting activity appear unrelated to either demographic and socioeconomic characteristics of GP practices or clinical outcome indicators.

Original languageEnglish
Article numbere026647
Number of pages12
JournalBMJ Open
Volume9
Issue number6
DOIs
Publication statusPublished - 21 Jun 2019

Keywords

  • chemical pathology
  • pathology
  • primary care
  • quality in health care

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