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Trends and between-Physician Variation in Laboratory Testing: A Retrospective Longitudinal Study in General Practice

Laboratory tests are frequently ordered by general practitioners (GPs), but little is known about time trends and between-GP variation of their use. In this retrospective longitudinal study, we analyzed over six million consultations by Swiss GPs during the decade 2009–2018. For 15 commonly used tes...

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Autores principales: Schumacher, Lisa D., Jäger, Levy, Meier, Rahel, Rachamin, Yael, Senn, Oliver, Rosemann, Thomas, Markun, Stefan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7355885/
https://www.ncbi.nlm.nih.gov/pubmed/32521786
http://dx.doi.org/10.3390/jcm9061787
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author Schumacher, Lisa D.
Jäger, Levy
Meier, Rahel
Rachamin, Yael
Senn, Oliver
Rosemann, Thomas
Markun, Stefan
author_facet Schumacher, Lisa D.
Jäger, Levy
Meier, Rahel
Rachamin, Yael
Senn, Oliver
Rosemann, Thomas
Markun, Stefan
author_sort Schumacher, Lisa D.
collection PubMed
description Laboratory tests are frequently ordered by general practitioners (GPs), but little is known about time trends and between-GP variation of their use. In this retrospective longitudinal study, we analyzed over six million consultations by Swiss GPs during the decade 2009–2018. For 15 commonly used test types, we defined specific laboratory testing rates (sLTR) as the percentage of consultations involving corresponding laboratory testing requests. Patient age- and sex-adjusted time trends of sLTR were modeled with mixed-effect logistic regression accounting for clustering of patients within GPs. We quantified between-GP variation by means of intraclass correlation coefficients (ICC). Nine out of the 15 laboratory test types considered showed significant temporal increases, most eminently vitamin D (ten-year odds ratio (OR) 1.88, 95% confidence interval (CI) 1.71–2.06) and glycated hemoglobin (ten-year OR 1.87, 95% CI 1.82–1.92). Test types both subject to substantial increase and high between-GP variation of sLTR were vitamin D (ICC 0.075), glycated hemoglobin (ICC 0.101), C-reactive protein (ICC 0.202), and vitamin B12 (ICC 0.166). Increasing testing frequencies and large between-GP variation of specific test type use pointed at inconsistencies of medical practice and potential overuse.
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spelling pubmed-73558852020-07-22 Trends and between-Physician Variation in Laboratory Testing: A Retrospective Longitudinal Study in General Practice Schumacher, Lisa D. Jäger, Levy Meier, Rahel Rachamin, Yael Senn, Oliver Rosemann, Thomas Markun, Stefan J Clin Med Article Laboratory tests are frequently ordered by general practitioners (GPs), but little is known about time trends and between-GP variation of their use. In this retrospective longitudinal study, we analyzed over six million consultations by Swiss GPs during the decade 2009–2018. For 15 commonly used test types, we defined specific laboratory testing rates (sLTR) as the percentage of consultations involving corresponding laboratory testing requests. Patient age- and sex-adjusted time trends of sLTR were modeled with mixed-effect logistic regression accounting for clustering of patients within GPs. We quantified between-GP variation by means of intraclass correlation coefficients (ICC). Nine out of the 15 laboratory test types considered showed significant temporal increases, most eminently vitamin D (ten-year odds ratio (OR) 1.88, 95% confidence interval (CI) 1.71–2.06) and glycated hemoglobin (ten-year OR 1.87, 95% CI 1.82–1.92). Test types both subject to substantial increase and high between-GP variation of sLTR were vitamin D (ICC 0.075), glycated hemoglobin (ICC 0.101), C-reactive protein (ICC 0.202), and vitamin B12 (ICC 0.166). Increasing testing frequencies and large between-GP variation of specific test type use pointed at inconsistencies of medical practice and potential overuse. MDPI 2020-06-08 /pmc/articles/PMC7355885/ /pubmed/32521786 http://dx.doi.org/10.3390/jcm9061787 Text en © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Schumacher, Lisa D.
Jäger, Levy
Meier, Rahel
Rachamin, Yael
Senn, Oliver
Rosemann, Thomas
Markun, Stefan
Trends and between-Physician Variation in Laboratory Testing: A Retrospective Longitudinal Study in General Practice
title Trends and between-Physician Variation in Laboratory Testing: A Retrospective Longitudinal Study in General Practice
title_full Trends and between-Physician Variation in Laboratory Testing: A Retrospective Longitudinal Study in General Practice
title_fullStr Trends and between-Physician Variation in Laboratory Testing: A Retrospective Longitudinal Study in General Practice
title_full_unstemmed Trends and between-Physician Variation in Laboratory Testing: A Retrospective Longitudinal Study in General Practice
title_short Trends and between-Physician Variation in Laboratory Testing: A Retrospective Longitudinal Study in General Practice
title_sort trends and between-physician variation in laboratory testing: a retrospective longitudinal study in general practice
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7355885/
https://www.ncbi.nlm.nih.gov/pubmed/32521786
http://dx.doi.org/10.3390/jcm9061787
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