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One study shows that the increasing pressure of workload in general practice can partly be explained by an increase in the number of ordered tests while GPs are assuming more services previously provided by hospitals.
A research team led by the Department of Health Sciences in Primary Health Care at Oxford University in Nuffield discovered that the number of diagnostic tests prescribed by general practitioners had been multiplied by 3 , 3 over a period of 15 years.
According to them, 2015-2016 patients underwent an average of five tests per year, compared with 1.5 in 2000-2001.
Work pressures for general practitioners
Write in Bmj , the researchers said the tests cost the NHS more than £ 2.8 billion a year, and that controlling and revising their results has increased the workload in primary care.
The observational study used electronic health record data from patients
enrolled in general practice practices that contribute to the Clinical Practice Research (CPRD) database from April 1, 2000 to March 31, 2016. Anonymous data contains electronic health records of primary care patients covering approximately 7% of the population of the United Kingdom.
The total number of tests significantly increased over time, in both sexes, in all age groups, types of tests (laboratory, imaging and various) and for 40 of the 44 tests specifically studied. .
The researchers found that the increase in the number of ordered tests was slightly higher in men (3.4-fold increase) compared to women (3.3-fold increase).
Elderly patients experienced the largest increase – an increase of 4.6 times for those over 85 years of age.
The average annual percentage increase in the test rate over the 15-year period was:
NHS service changes
The researchers suggested that the increase in the number of tests could be due in part to changes in the provision of NHS services, under which the ability of GPs to order diagnostic tests, particularly for those who have been diagnosed with HIV. imaging, it's increased.
In addition, many services were transferred from secondary care to primary care during this period with the introduction of quality framework and results encouraging generalists to monitor chronic diseases with the help of stress tests. laboratory.
The increase could also be "a direct response to the increase in the number and duration of consultations with general practitioners, tests being used for" non-medical strategic reasons ", such as reassuring patients and end the consultations, "said the authors.
In addition, patients can request more tests as they become more informed and are encouraged to participate in decisions about their care.
The authors point out that the nature of their observational study meant that no definitive conclusion could be drawn about the causes and effects.
Nevertheless, according to them, whatever factors contributed to increased use of the tests, this would have major consequences for the workload of general practitioners and the NHS budget.
"Difficult" situation for generalists
Professor Helen Stokes-Lampard, President of the Royal College of GPs, said: "GPs are in an extremely difficult position when it comes to making recommendations or asking for blood tests or testing. 39 other investigations, because we are criticized when it is what we do and we criticize when we do not.At the end, our priority goes to our patients and we will work in their best interest.
"This research examines the increase in the number of GPs testing requests, but not the reasons why they were deemed appropriate and whether they were appropriate – and both should be the key to deciding whether an increase is positive or not. no.
"The fact that more varied and more accurate diagnostic tests are available in the NHS in the last 15 years is a good thing – but it has a cost." It is obviously important to take into account NHS resources when you decide to ask for a test, but general practitioners and their teams do not make the decision lightly, or if they do not think that they will really help to reduce what might not be the case in a patient.
"We are now serving a growing and aging population, and many patients are living with multiple morbidities, so, as this report shows, the number of tests done in the community will increase quite appropriately. GPs and our teams need better access to diagnostic testing in the community so that we can make a more informed decision about the demand for more specialized testing or referring to a health center. the hospital. "
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 documents: https://doi.org/10.1136/bmj.k4666 (Published November 28, 2018). BMJ 2018; 363: k4666. Abstract.
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