Inappropriate use of laboratory tests: How availability triggers demand - Examples across Europe

Area of Science:

• Clinical Chemistry
• Laboratory Medicine
• Healthcare Management

Background:

• Appropriate use of laboratory diagnostics is a critical concern in healthcare.
• Under- and overutilization of tests can lead to inefficiencies and impact patient outcomes.

Purpose of the Study:

• To illustrate paradigmatic examples of laboratory test under- and overutilization across Europe.
• To identify potential solutions for optimizing diagnostic test ordering and use.

Main Methods:

• Analysis of six case studies from five European countries.
• Observation of changes in laboratory test orders following specific organizational interventions.
• Exclusion of variations attributed to changes in patient populations.

Main Results:

• Examples include assay switches (BNP to NT-proBNP, increasing use by 374%) and new technology adoption (Influenza RNA detection, increasing use by 450%).
• Implementation of gatekeeping strategies reduced tumor marker use (15-61%), while assay removal (CK-MB, GGT) also decreased utilization.
• Insourcing of Vitamin D testing led to a 378% increase in demand.

Conclusions:

• Laboratory resource availability can significantly influence test demand, indicating widespread inappropriate use.
• Simple strategies can effectively address issues of under- and overutilization.
• Laboratory specialists should focus on extra-analytical processes and interdisciplinary collaboration.