Beijer C, De Jong AM, Statius Muller I, Eysink Smeets JBE, Pronk-Admiraal C. Blood test requests after diagnostic consultation. Huisarts Wet 2016;59(6):434-8.
Background
The Dutch College of General Practitioners guideline ‘Anaemia’ provides a focused policy for requesting laboratory tests to establish a diagnosis of anaemia and is supported by the use of a problem-guided request form. In order to stimulate appropriate and cost-effective testing, clinical chemists from Atalmedial have started an anaemia diagnostic consultation for general practitioners, during which clinical chemists discuss the tests mentioned in the guideline. The aim of this study was to evaluate the effect of this diagnostic consultation on GP requests for anaemia tests.
Method
The impact of the diagnostic consultation was assessed by comparing the number of tests requested before and after the consultation by 20 groups of GPs (in total 146 GPs) who had participated in the diagnostic consultation and 12 groups of clinical chemists (in total 93 GPs) who had not participated in the consultation. Statistical analysis was performed by means of the non-parametric Mann-Whitney U test.
Results
The effect of participation in the diagnostic consultation differed by region. In the Amsterdam region, participation led to a significant decrease in the number of requests for folic acid testing, whereas participation did not lead to a significant decrease in the number of tests ordered in the Haarlem region. In the Leiden region, participation led to a significant decrease in the number of requests for tests for iron, transferrin, vitamin B12, and folic acid. Over the entire area covered by Atalmedial services, there was a significant decrease in the number of requests for tests for iron, transferrin, vitamin B12, folic acid and thrombocytes.
Conclusion
Participation in a diagnostic consultation led to a more appropriate and economic use of laboratory diagnostics. The changes in the policy for requesting tests are in part dependent on how medical laboratories handled test requests in the past.