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  • Better use of primary care laboratory services following interventions to ‘market’ clinical guidelines in New Zealand: a controlled before-and-after study

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Quality improvement report
Better use of primary care laboratory services following interventions to ‘market’ clinical guidelines in New Zealand: a controlled before-and-after study
  1. Andrew Tomlin1,
  2. Susan Dovey2,
  3. Robin Gauld3,
  4. Murray Tilyard1,2
  1. 1Best Practice Advocacy Centre, Dunedin, New Zealand
  2. 2Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
  3. 3Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
  1. Correspondence to Dr Susan Dovey, University of Otago, PO Box 913, Dunedin 9016, New Zealand; susan.dovey{at}otago.ac.nz

Abstract

Context Laboratory tests for inflammatory response, thyroid function and infectious diarrhoea were not being ordered as recommended by clinical guidelines.

Objective To measure changes in community laboratory-test ordering following marketing programmes promoting guidelines recommendations.

Design Controlled before-and-after study involving 2 years of national laboratory payment data before and after each intervention. Comparisons were with doctors ordering the same tests but not receiving interventions.

Setting New Zealand primary care.

Participants 3161, 3140 and 3335 general practitioners and 2424, 2443 and 2766 Comparison doctors ordering inflammatory response, thyroid function and acute diarrhoea tests from community laboratories, July 2003 to March 2009.

Interventions Three separate marketing programmes to general practitioners, each comprising written material advising of guidelines recommendations, individual laboratory-test use feedback and professional development opportunities.

Main outcome measures Number of tests, tests/doctor, patients having tests and tested patients/doctor/year before and after each intervention. Change in expenditure from before each intervention to after.

Results For Intervention doctors, erythrocyte sedimentation rate tests decreased 60.0% after the intervention; tests for C-reactive protein increased 63.1%; simultaneous erythrocyte sedimentation rate and C-reactive protein orders decreased 32.6%. Tests for free thyroxine and free triiodothyronine decreased 44.1% and 36.0%. The proportion of thyroid function tests where thyroid-stimulating hormone was the sole test ordered increased from 43.2% before the intervention to 65.2% afterwards (p<0.001; 95% CI 21.7% to 22.2%). Testing for faecal culture decreased 31.5%, giardia and cryptosporidium 31.5%, and ova and parasites 56.9%. Faecal culture as the sole initial test increased from 31.4% to 39.1% (p<0.001; 95% CI 7.2% to 8.2%). Testing by Comparison doctors changed in the same direction but with significantly less magnitude. The estimated reduction in expenditure for study tests was 23.5%.

Conclusions Clear information marketed to general practitioners improved the quality of laboratory test ordering for patients in New Zealand.

https://doi.org/10.1136/bmjqs.2010.048124

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    Footnotes

    • AT and MT had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. The study was completed as part of the ongoing evaluation by BPACnz of its programmes. BPACnz has five shareholders: IPAC, Pegasus Health, ProCare Health, South Link Health, and the University of Otago. BPACnz is contracted to the Pharmaceutical Management Agency (PHARMAC), the government agency responsible for national pharmaceutical subsidy expenditure and District Health Boards New Zealand (DHBNZ), to market evidence-based recommendations and guidelines to New Zealand's general practitioners on prescribing and laboratory test investigations, respectively. Study data were accessed as part of the DHBNZ contract, but the research was conducted independently of DHBNZ.

    • Funding This research was completed as part of the authors' employment in Best Practice Advocacy Centre (BPACnz) or its stakeholder organisations.

    • Competing interests None.

    • Provenance and peer review Not commissioned; externally peer reviewed.