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

• Published in: Journal of clinical medicine Vol. 9; no. 6; p. 1787
• Main Authors: Schumacher, Lisa D., Jäger, Levy, Meier, Rahel, Rachamin, Yael, Senn, Oliver, Rosemann, Thomas, Markun, Stefan
• Format: Journal Article
• Language: English
• Published: Basel MDPI AG 08.06.2020; MDPI
• Subjects: Age; Blood tests; Clinical medicine; Electronic health records; Exports; Family physicians; Laboratories; Longitudinal studies; Medical records; Patient satisfaction; Primary care; Software; Trends; Switzerland
• ISSN: 2077-0383; 2077-0383
• DOI: 10.3390/jcm9061787

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.