The effectiveness of interventions to improve laboratory requesting patterns among primary care physicians: a systematic review

Hdl Handle:
http://hdl.handle.net/10147/583478
Title:
The effectiveness of interventions to improve laboratory requesting patterns among primary care physicians: a systematic review
Authors:
Cadogan, Sharon L; Browne, John P; Bradley, Colin P; Cahill, Mary R
Citation:
Implementation Science. 2015 Dec 05;10(1):167
Issue Date:
5-Dec-2015
URI:
http://dx.doi.org/10.1186/s13012-015-0356-4; http://hdl.handle.net/10147/583478
Abstract:
Abstract Background Laboratory testing is an integral part of day-to-day primary care practice, with approximately 30 % of patient encounters resulting in a request. However, research suggests that a large proportion of requests does not benefit patient care and is avoidable. The aim of this systematic review was to comprehensively search the literature for studies evaluating the effectiveness of interventions to improve primary care physician use of laboratory tests. Methods A search of PubMed, Cochrane Library, Embase and Scopus (from inception to 09/02/14) was conducted. The following study designs were considered: systematic reviews, randomised controlled trials (RCTs), controlled clinical trials (CCTs), controlled before and after studies (CBAs) and interrupted time series analysis (ITSs). Studies were quality appraised using a modified version of the Effective Practice and Organisation of Care (EPOC) checklist. The population of interest was primary care physicians. Interventions were considered if they aimed to improve laboratory testing in primary care. The outcome of interest was a volume of laboratory tests. Results In total, 6,166 titles and abstracts were reviewed, followed by 87 full texts. Of these, 11 papers were eligible for inclusion in the systematic review. This included four RCTs, six CBAs and one ITS study. The types of interventions examined included education, feedback, guidelines, education with feedback, feedback with guidelines and changing order forms. The quality of included studies varied with seven studies deemed to have a low risk of bias, three with unclear risk of bias and one with high risk of bias. All but one study found significant reductions in the volume of tests following the intervention, with effect sizes ranging from 1.2 to 60 %. Due to heterogeneity, meta-analysis was not performed. Conclusions Interventions such as educational strategies, feedback and changing test order forms may improve the efficient use of laboratory tests in primary care; however, the level of evidence is quite low and the quality is poor. The reproducibility of findings from different laboratories is also difficult to ascertain from the literature. Some standardisation of both interventions and outcome measures is required to enable formal meta-analysis.
Language:
en
Keywords:
GENERAL PRACTITIONERS; LABORATORY SERVICE

Full metadata record

DC FieldValue Language
dc.contributor.authorCadogan, Sharon Len
dc.contributor.authorBrowne, John Pen
dc.contributor.authorBradley, Colin Pen
dc.contributor.authorCahill, Mary Ren
dc.date.accessioned2015-12-09T12:45:51Zen
dc.date.available2015-12-09T12:45:51Zen
dc.date.issued2015-12-05en
dc.identifier.citationImplementation Science. 2015 Dec 05;10(1):167en
dc.identifier.urihttp://dx.doi.org/10.1186/s13012-015-0356-4en
dc.identifier.urihttp://hdl.handle.net/10147/583478en
dc.description.abstractAbstract Background Laboratory testing is an integral part of day-to-day primary care practice, with approximately 30 % of patient encounters resulting in a request. However, research suggests that a large proportion of requests does not benefit patient care and is avoidable. The aim of this systematic review was to comprehensively search the literature for studies evaluating the effectiveness of interventions to improve primary care physician use of laboratory tests. Methods A search of PubMed, Cochrane Library, Embase and Scopus (from inception to 09/02/14) was conducted. The following study designs were considered: systematic reviews, randomised controlled trials (RCTs), controlled clinical trials (CCTs), controlled before and after studies (CBAs) and interrupted time series analysis (ITSs). Studies were quality appraised using a modified version of the Effective Practice and Organisation of Care (EPOC) checklist. The population of interest was primary care physicians. Interventions were considered if they aimed to improve laboratory testing in primary care. The outcome of interest was a volume of laboratory tests. Results In total, 6,166 titles and abstracts were reviewed, followed by 87 full texts. Of these, 11 papers were eligible for inclusion in the systematic review. This included four RCTs, six CBAs and one ITS study. The types of interventions examined included education, feedback, guidelines, education with feedback, feedback with guidelines and changing order forms. The quality of included studies varied with seven studies deemed to have a low risk of bias, three with unclear risk of bias and one with high risk of bias. All but one study found significant reductions in the volume of tests following the intervention, with effect sizes ranging from 1.2 to 60 %. Due to heterogeneity, meta-analysis was not performed. Conclusions Interventions such as educational strategies, feedback and changing test order forms may improve the efficient use of laboratory tests in primary care; however, the level of evidence is quite low and the quality is poor. The reproducibility of findings from different laboratories is also difficult to ascertain from the literature. Some standardisation of both interventions and outcome measures is required to enable formal meta-analysis.en
dc.language.isoenen
dc.subjectGENERAL PRACTITIONERSen
dc.subjectLABORATORY SERVICEen
dc.titleThe effectiveness of interventions to improve laboratory requesting patterns among primary care physicians: a systematic reviewen
dc.language.rfc3066enen
dc.rights.holderCadogan et al.en
dc.date.updated2015-12-08T20:19:03Zen
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