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Long-term effects of an education programme on the optimal use of clinical chemistry testing in primary health care
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Chemistry. (Biokemisk struktur och funktion)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Chemistry. (Biokemisk struktur och funktion)
2009 (English)In: Scandinavian Journal of Clinical and Laboratory Investigation, ISSN 0036-5513, E-ISSN 1502-7686, Vol. 69, no 4, 481-486 p.Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
2009. Vol. 69, no 4, 481-486 p.
Keyword [en]
continuing medical education, cost control, cost savings, organizational efficiency, physician practice patterns, routine diagnostic tests
National Category
Other Clinical Medicine
Research subject
Biomedical Laboratory Science
Identifiers
URN: urn:nbn:se:uu:diva-119610DOI: 10.1080/00365510902749123ISI: 000267287000007PubMedID: 19340700OAI: oai:DiVA.org:uu-119610DiVA: diva2:300566
Available from: 2010-02-26 Created: 2010-02-26 Last updated: 2017-12-12Bibliographically approved
In thesis
1. The Use of Laboratory Analyses in Sweden: Quality and Cost-Effectiveness in Test Utilization
Open this publication in new window or tab >>The Use of Laboratory Analyses in Sweden: Quality and Cost-Effectiveness in Test Utilization
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Laboratory analyses, essential in screening, diagnosis, treatment, and monitoring of disease, are indispensable in health care, but appropriate utilization is intricate. The overall aim of this thesis was to study the use of laboratory tests in Sweden with the objective to evaluate and optimize test utilization.

Considerable inter-county variations in test utilization in primary health care in Sweden were found; variations likely influenced by local traditions and habits of test ordering leading to over- as well as underutilization. Optimized test utilization was demonstrated to convey improved quality and substantial cost savings.

It was further established that continuing medical education is a suitable means of optimizing test utilization, and consequently enhancing quality and cost-efficiency, as such education was demonstrated to achieve long-lasting improvements in the test ordering habits of primary health care physicians.

Laboratory tests are closely associated with other, greater, health care costs, but their indirect effects on other areas of medicine are rarely evaluated or measured in monetary terms. In an illustrative example of the effects that optimal test utilization may have on associated health care costs it was demonstrated that F-calprotectin, a fecal marker of intestinal inflammation, has the potential to substantially reduce the number of invasive investigations necessary in, and the costs associated with, the diagnosis of Inflammatory Bowel Disease.

Information on trends in test utilization is essential to optimal financial management of laboratories. A longitudinal evaluation revealed that test utilization had increased by 70% in 6 years, and even though the selection of tests more than doubled, a very small number of tests represented a stable, and disproportionally large, share of the total number of tests ordered. The study defines trends and thus has potential predictive values.

In summary, appropriate utilization of laboratory analyses has both clinical and economical benefits on all levels of health care.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2010. 66 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 538
Keyword
continuing medical education, cost control, cost savings, physician practice patterns, diagnostic tests, clinical chemistry, primary health care, health care costs, laboratory management, test utilization, trends, cost-effectiveness, inflammatory bowel disease, irritable bowel syndrome, calprotectin, cost avoidance
National Category
Other Clinical Medicine
Research subject
Biomedical Laboratory Science
Identifiers
urn:nbn:se:uu:diva-120554 (URN)978-91-554-7751-6 (ISBN)
Public defence
2010-05-07, Enghoffsalen, Ing 50, bv, Akademiska sjukhuset, Uppsala, 09:15 (Swedish)
Opponent
Supervisors
Available from: 2010-04-14 Created: 2010-03-12 Last updated: 2010-04-16

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