Pathology test-ordering behaviour of Australian general practice trainees a cross-sectional analysis

• Published in: International journal for quality in health care Vol. 27; no. 6; pp. 528 - 535
• Main Authors: MORGAN, SIMON, HENDERSON, KIM M., TAPLEY, AMANDA, SCOTT, JOHN, VAN DRIEL, MIEKE L., SPIKE, NEIL A., MCARTHUR, LAWRIE A., DAVEY, ANDREW R., OLDMEADOW, CHRIS, BALL, JEAN, MAGIN, PARKER J.
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01.12.2015
• Subjects: Australia; Cross-Sectional Studies; Diagnostic Tests, Routine; General Practice; General Practitioners - education; Practice Patterns, Physicians; Australia; pathology; appropriate health care; under-use and over-use; primary care/general practice; setting of care; appropriateness; human resources; laboratory test; training/education
• ISSN: 1353-4505; 1464-3677
• DOI: 10.1093/intqhc/mzv086

In the context of increasing over-testing and the implications for patient safety, to establish the prevalence and nature of pathology test-ordering of GP trainees, and to describe the associations of this test-ordering. A cross-sectional analysis of data from the Registrar Clinical Encounters in Training (ReCEnT) cohort study. Five of Australia's 17 general practice regional training providers, encompassing urban-to-very remote practices. GP trainees. The number of pathology tests ordered per problem/diagnosis managed. A total of 856 individual trainees (response rate 95.2%) contributed data from 1832 trainee-terms, 108 759 encounters and 169 304 problems. Pathology test-ordering prevalence was 79.3 tests (95% CI: 78.8-79.8) per 100 encounters, 50.9 (95% CI: 50.6-51.3) per 100 problems, and at least 1 test was requested in 22.4% of consultations. Most commonly ordered was full blood count (6.1 per 100 problems). The commonest problem prompting test-ordering was 'check-up' (18.6%). Test-ordering was significantly associated, on multivariable analysis, with the trainee having worked at the practice previously; the patient being adult, male and new to both trainee and practice; the practice being urban; the problem/diagnosis being new; imaging being ordered; referral being made and follow-up being arranged. Trainees were significantly less likely to order tests for problems/diagnoses for which they had sought in-consultation information or advice. Compared with the established GPs, trainees order more pathology tests per consultation and per problem managed, and in a higher proportion of consultations. Our findings will inform educational policy to enhance quality and safety in general practice training.