BACKGROUND: Approximately 13% of consultations in general practice involve patients with unexplained complaints (UCs). These consultations often end with general practitioners (GPs) ordering blood tests of questionable diagnostic informativeness. OBJECTIVE: We studied factors potentially associated with GPs' decisions to order blood tests. METHODS: Cross-sectional study. Twenty-seven GPs completed registration forms after each consultation concerning newly presented UCs. RESULTS: Of the 100 analysable patients, 59 had at least one blood test ordered. The median number of ordered tests was 10 (interpercentile range [IPR-90] 2-15). Compared to abdominal complaints, the blood test ordering (BTO) probability for fatigue was five times higher (relative risk [RR] 5.2). Duration of complaints for over 4 weeks also increased this probability (RR 1.6). Factors associated with a lower BTO probability were: likelihood of background psychosocial factors (RR 0.4) and GPs having a syndrome rather than symptom type of working hypothesis (RR 0.5). CONCLUSION: We found a high rate of BTO among GPs confronted with patients with UCs. Furthermore, a considerable number of tests were ordered. The selectivity in BTO behaviour of GPs can be improved upon.
BACKGROUND: Approximately 13% of consultations in general practice involve patients with unexplained complaints (UCs). These consultations often end with general practitioners (GPs) ordering blood tests of questionable diagnostic informativeness. OBJECTIVE: We studied factors potentially associated with GPs' decisions to order blood tests. METHODS: Cross-sectional study. Twenty-seven GPs completed registration forms after each consultation concerning newly presented UCs. RESULTS: Of the 100 analysable patients, 59 had at least one blood test ordered. The median number of ordered tests was 10 (interpercentile range [IPR-90] 2-15). Compared to abdominal complaints, the blood test ordering (BTO) probability for fatigue was five times higher (relative risk [RR] 5.2). Duration of complaints for over 4 weeks also increased this probability (RR 1.6). Factors associated with a lower BTO probability were: likelihood of background psychosocial factors (RR 0.4) and GPs having a syndrome rather than symptom type of working hypothesis (RR 0.5). CONCLUSION: We found a high rate of BTO among GPs confronted with patients with UCs. Furthermore, a considerable number of tests were ordered. The selectivity in BTO behaviour of GPs can be improved upon.
Authors: Marloes A van Bokhoven; Hèlen Koch; Trudy van der Weijden; Anuska H M Weekers-Muyres; Patrick J E Bindels; Richard P T M Grol; Geert-Jan Dinant Journal: Implement Sci Date: 2012-04-04 Impact factor: 7.327
Authors: Jack W O'Sullivan; Sarah Stevens; F D Richard Hobbs; Chris Salisbury; Paul Little; Ben Goldacre; Clare Bankhead; Jeffrey K Aronson; Rafael Perera; Carl Heneghan Journal: BMJ Date: 2018-11-28
Authors: Tjitske M Vreugdenhil; Mariska Leeflang; Joppe W Hovius; Hein Sprong; Jettie Bont; C W Ang; Jeanette Pols; Henk C P M Van Weert Journal: Eur J Gen Pract Date: 2020-03-11 Impact factor: 1.904