Simon Morgan1, Kim M Henderson1, Amanda Tapley1, John Scott1, Mieke L Van Driel2, Neil A Spike3, Lawrie A Mcarthur4, Andrew R Davey5, Chris Oldmeadow6, Jean Ball6, Parker J Magin7. 1. General Practice Training Valley to Coast, PO Box 573, HRMC, Mayfield, NSW 2310, Australia. 2. Discipline of General Practice, School of Medicine, The University of Queensland, L8 Health Sciences Building, Royal Brisbane and Women's Hospital, Brisbane ALD 4029, Australia. 3. Victorian Metropolitan Alliance General Practice Training, 15 Cato Street, Hawthorn, VIC 3122, Australia. 4. Adelaide to Outback General Practice Training, Lower Level, 183 Melbourne Street, North Adelaide, SA 5006, Australia. 5. Discipline of General Practice, University of Newcastle, Newbolds Building, University Drive, Callaghan, NSW 2308, Australia. 6. Hunter Medical Research Unit, Locked Bag 1000, New Lambton, NSW 2305, Australia. 7. General Practice Training Valley to Coast, PO Box 573, HRMC, Mayfield, NSW 2310, Australia Discipline of General Practice, University of Newcastle, Newbolds Building, University Drive, Callaghan, NSW 2308, Australia.
Abstract
OBJECTIVE: 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. DESIGN: A cross-sectional analysis of data from the Registrar Clinical Encounters in Training (ReCEnT) cohort study. SETTING: Five of Australia's 17 general practice regional training providers, encompassing urban-to-very remote practices. PARTICIPANTS: GP trainees. MAIN OUTCOME MEASURES: The number of pathology tests ordered per problem/diagnosis managed. RESULTS: 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. CONCLUSIONS: 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.
OBJECTIVE: 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. DESIGN: A cross-sectional analysis of data from the Registrar Clinical Encounters in Training (ReCEnT) cohort study. SETTING: Five of Australia's 17 general practice regional training providers, encompassing urban-to-very remote practices. PARTICIPANTS: GP trainees. MAIN OUTCOME MEASURES: The number of pathology tests ordered per problem/diagnosis managed. RESULTS: 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. CONCLUSIONS: 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.
Keywords:
appropriate health care; appropriateness; human resources; laboratory test; pathology; primary care/general practice; setting of care; training/education; under-use and over-use
Authors: Parker Magin; Anna Ralston; Amanda Tapley; Elizabeth Holliday; Jean Ball; Mieke L van Driel; Andrew Davey; Linda Klein; Kristen FitzGerald; Neil Spike; Alison Fielding Journal: BMJ Open Date: 2022-05-11 Impact factor: 3.006