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Costly regional variations in primary health care test utilization in Sweden
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Chemistry.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , UCR-Uppsala Clinical Research center.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Chemistry. (Biokemisk struktur och funktion)
2010 (English)In: Scandinavian Journal of Clinical and Laboratory Investigation, ISSN 0036-5513, Vol. 70, no 3, 164-170 p.Article in journal (Refereed) Published
Abstract [en]

Objective: Laboratory tests are used increasingly in primary health care and they are thus associated with rapidly growing costs. Variations in clinical practice, an important determinant of expenditure for laboratory tests, could further increase the financial burden. The study's threefold objective was to determine the presence and extent of regional variations in test ordering between eight counties in Sweden, to investigate the influence on these variations by factors earlier described in the literature as explanatory, and to calculate the achievable savings that could be realized through optimized test ordering. Design: A retrospective study using test request data. Setting: A total of 223 primary health care centers in eight counties in Sweden. Main outcome measures: Thirteen ratios of commonly used laboratory tests, demographic data and the number of ordered tests per 1000 inhabitants served as the basis of comparison. The total savings per 100,000 inhabitants that could be achieved through optimized test ordering was estimated. Results: Large variations were found between all studied counties for all investigated ratios. However, none of the demographic variables investigated seemed to be able to explain the full extent of the variations. The range of achievable yearly savings per 100,000 inhabitants was euro14,000-euro185,000. Conclusion: The inter-county variations in Sweden are large and the savings associated with optimized test utilization are substantial. The investigated factors previously described as explaining the variations in test ordering only seem to explain a small part of the variation, and the variations are likely influenced by regional habits and traditions.

Place, publisher, year, edition, pages
2010. Vol. 70, no 3, 164-170 p.
Keyword [en]
clinical chemistry tests, cost savings, diagnostic tests, family practice, health care costs, physicians' practice patterns
National Category
Medical and Health Sciences
Research subject
Biomedical Laboratory Science
URN: urn:nbn:se:uu:diva-120551DOI: 10.3109/00365511003642519ISI: 000276814500004PubMedID: 20178451OAI: oai:DiVA.org:uu-120551DiVA: diva2:303557
Available from: 2010-03-12 Created: 2010-03-12 Last updated: 2011-02-25Bibliographically 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.
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 538
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
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)
Available from: 2010-04-14 Created: 2010-03-12 Last updated: 2010-04-16

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