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Overtesting and undertesting in primary care: a systematic review and meta-analysis.
Jack W O'Sullivan1, Ali Albasri1, Brian D Nicholson1
1Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Science, University of Oxford, Oxford, UK.
BMJ Open
|February 15, 2018
Summary
Diagnostic test use in primary care shows significant overuse and underuse, wasting resources and delaying care. Echocardiography use is consistently poor, with wide variations in other tests like pulmonary function tests.
Area of Science:
- Health Services Research
- Diagnostic Test Utilization
- Primary Care Medicine
Background:
- Health systems face significant financial strain.
- Inappropriate diagnostic test use (overuse and underuse) contributes to waste and delayed patient care.
- Primary care settings are crucial for optimizing diagnostic test utilization.
Purpose of the Study:
- To systematically identify and quantify the overuse and underuse of diagnostic tests in primary care settings.
- To analyze variations in inappropriate test ordering across different diagnostic procedures.
Main Methods:
- A systematic review and meta-analysis was conducted.
- Searched MEDLINE and Embase databases from January 1999 to October 2017.
- Included 63 studies encompassing 357,171 adult patients to assess diagnostic test inappropriateness against established guidelines.
Main Results:
- Analysis of 103 measures of inappropriateness (41 underuse, 62 overuse) for 47 diagnostic tests.
- 17 tests were underused in over 50% of cases, notably echocardiography (54%-89%).
- 11 tests were overused in over 50% of cases, including echocardiography (77%-92%) and variable overuse of urinary cultures, upper endoscopy, and colonoscopy.
Conclusions:
- Significant variation exists in the appropriate use of diagnostic tests within primary care.
- Echocardiography demonstrates consistently poor utilization, with both underuse and overuse.
- Pulmonary function tests, upper endoscopy, urinary cultures, and colonoscopy exhibit substantial inappropriate underuse and overuse.
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