OnMedica – News – General Practitioners Order Three Times More Diagnostic Tests Than 15 Years Ago

Generalist-controlled tests cost the NHS about £ 2.8 billion a year

Doctors currently order more than three times as many diagnostic tests for their patients as 15 years ago, says a study * published today in Bmj.

Researchers found that tests cost the NHS more than £ 2.8 billion a year, but this is due to the fact that general practitioners are now providing more services previously provided by hospitals and are monitoring more patients with chronic diseases. .

A team of researchers from Oxford, Bristol and Southampton Universities used the Clinical Practice Research Datalink (CPRD) software, a database of patients registered in general practice, to badyze the evolution of the number of ordered tests. by general practitioners between April 1, 2000 and March 31, 2016.

They found that between 2000/01 and 2015/16, the number of tests per 10,000 person-years increased 3.3-fold from 14,869 to 49,267, an increase of 8.5 % per year.

The results showed that, on average, 2015-2016 patients underwent five tests per year, compared to 1.5 tests in 2000-01 and that the increase in the number of ordered tests was slightly higher in men. (3.4 times more) than in women. (Increase of 3.3 fold), but more important in elderly patients (4.6-fold increase in patients over 85 years of age).

The researchers examined 44 specific tests, including 28 laboratory tests, 11 imaging tests, and five miscellaneous tests, such as spirometry, cervical smears, and electrocardiography.

Significant increases in the number of ordered tests were observed for 40 of the 44 individual tests and for the three different test groups (laboratory, imagery and miscellaneous).

The increased number of tests may be due in part to changes in the provision of NHS services, they said, citing examples such as:

• Generalists' ability to order expanded diagnostic (including imaging) tests
• many services have been transferred from secondary care to primary care requiring testing and must be ordered by GPs rather than hospitals
• the QOF, which encourages GPs to monitor chronic diseases with the help of laboratory tests, has been introduced.

The increased number of tests could also reflect the increasing number and duration of consultations in general practice, with tests being used for "non-medical strategic reasons," such as rebaduring patients and ending consultations, they added.

This could also reflect patients' greater expectations for testing.

The authors admitted that it was an observational study. No definitive conclusion could thus be drawn as to the cause and the effect.

Nevertheless, they said: "Whatever factors contribute to increased use of the tests, our results may have major implications for the workload of general practitioners. Greater use of testing will likely lead to more consultation and increased workload related to non-consultation. "

Assuming that the examination of a test took up to three minutes, the authors estimated that the general practitioner spent an average of 1.5 to 2 hours examining the test results every working day of 2015-2016.

According to NICE estimates, the average cost of a lab test was £ 6, an imaging test at £ 29 and a miscellaneous test at £ 53. The authors estimated that the tests ordered by the general practice cost GBP 2.8 billion in 2015-2016 – £ 1.8 billion for laboratory tests, £ 400,000 for imaging and £ 600,000 for laboratory tests. various tests.

Professor Helen Stokes-Lampard, chair of the Royal College of General Practitioner, said, "This study examines the increase in the number of GP testing requests, but not the judgments as to whether an increase is positive or not.

"It is obviously important to take NHS resources into account before deciding to apply for a test, but general practitioners and their teams do not take the decision lightly, or if they do not think they will actually contribute to reduce the risk of error. a patient."

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* O'Sullivan JW, et al. Temporal Trends in the Use of Tests in Primary Care in the United Kingdom, 2000-2015: A Retrospective Analysis of 250 Million Tests. BMJ 2018; 363: k4666. DOI: 10.1136 / bmj.k4666