A laboratory demand optimisation project in primary care

Abstract

AbstractBackgroundThere is evidence of increasing use of laboratory tests with substantial variation between clinical teams which is difficult to justify on clinical grounds. The aim of this project was to assess the effect of a demand optimisation intervention on laboratory test requesting in primary care.MethodsThe intervention comprised educational initiatives, feedback to 55 individual practices on test request rates with ranking relative to other practices, and a small financial incentive for practices to engage and reflect on their test requesting activity. Data on test request numbers were collected from the laboratory databases for consecutive 12 month periods; pre‐intervention 2011-12, intervention 2012-13, 2013-14, 2014-15, and post-intervention 2015-16.ResultsThe intervention was associated with a 3.6% reduction in the mean number of profile test requests between baseline and 2015-16, although this was seen only in rural practices. In both rural and urban practices, there was a significant reduction in-between practice variability in request rates. The mean number of HbA1crequests increased from 1.9 to 3.0 per practice patient with diabetes. Variability in HbA1crequest rates increased from 23.8% to 36.6%. At all considered time points, test request rates and variability were higher in rural than in urban areas.ConclusionsThe intervention was associated with a reduction in both the volume and between practice variability of profile test requests, with differences noted between rural and urban practices. The increase in HbA1crequests may reflect a more appropriate rate of diabetes monitoring and also the adoption of HbA1cas a diagnostic test.Strengths & limitations of the studyWe assessed the effect of a laboratory demand optimisation intervention both on the value and between GP practice variability in laboratory test requesting.The changes in laboratory test requesting were separately evaluated for rural and urban GP practices.Other factors (GP practice organisation, characteristics of general practitioners) potentially affecting between practice differences in laboratory test ordering were not taken into account due to data unavailability.The demand management initiative was not accompanied by the cost-effectiveness analysis.The demand optimisation intervention was conducted in a Northern Ireland (NI) Western Health and Social Care Trust and the findings have not been independently replicated in any other NI trusts.