Pathology test-ordering behaviour of Australian general practice trainees: a cross-sectional analysis

Morgan, Simon, Henderson, Kim M., Tapley, Amanda, Scott, John, Van Driel, Mieke L., Spike, Neil A., Mcarthur, Lawrie A., Davey, Andrew R., Oldmeadow, Chris, Ball, Jean and Magin, Parker J. (2015) Pathology test-ordering behaviour of Australian general practice trainees: a cross-sectional analysis. International Journal for Quality in Health Care, 27 6: 528-535. doi:10.1093/intqhc/mzv086

Author Morgan, Simon
Henderson, Kim M.
Tapley, Amanda
Scott, John
Van Driel, Mieke L.
Spike, Neil A.
Mcarthur, Lawrie A.
Davey, Andrew R.
Oldmeadow, Chris
Ball, Jean
Magin, Parker J.
Title Pathology test-ordering behaviour of Australian general practice trainees: a cross-sectional analysis
Journal name International Journal for Quality in Health Care   Check publisher's open access policy
ISSN 1353-4505
Publication date 2015-12
Year available 2015
Sub-type Article (original research)
DOI 10.1093/intqhc/mzv086
Open Access Status Not Open Access
Volume 27
Issue 6
Start page 528
End page 535
Total pages 8
Place of publication Cary, NC United States
Publisher Oxford University Press
Collection year 2016
Language eng
Formatted 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 Measure(s) 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.
Keyword Appropriateness
Under-use and over-use
Appropriate health care
Primary care/general practice
Setting of care
Human resources
Laboratory test
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Discipline of General Practice Publications
Official 2016 Collection
School of Medicine Publications
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Citation counts: TR Web of Science Citation Count  Cited 1 times in Thomson Reuters Web of Science Article | Citations
Scopus Citation Count Cited 1 times in Scopus Article | Citations
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