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Variation in laboratory testing for patients with long-term conditions: a longitudinal cohort study in UK primary
Timothy Jones1,2,3, Rita Patel4,2,3, Martha M C Elwenspoek4,2
1The National Institute for Health Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol NHS Foundation Trust, Bristol, UK Timothy.Jones@bristol.ac.uk.
Insights
Laboratory test use for monitoring long-term conditions in the UK shows variation. While rates are stable, some practices undertest or overtest, indicating a need for standardized monitoring guidelines.
Area of Science:
- Clinical Chemistry
- Health Services Research
- Primary Care Medicine
Background:
- Laboratory test utilization has risen in the UK over recent decades.
- Significant geographical disparities in testing frequency have been observed.
Purpose of the Study:
- To investigate laboratory test usage for monitoring patients with hypertension, type 2 diabetes, or chronic kidney disease.
- To assess variations in test utilization across UK primary care settings.
Main Methods:
- A longitudinal cohort study utilized Clinical Practice Research Datalink (CPRD) primary care data from June 2013 to May 2018.
- Analysis examined testing rates over time, stratified by GP practice, patient demographics, and socioeconomic deprivation, with age-sex standardization.
Main Results:
- The study included nearly 1 million patients and over 27 million tests, with renal function, liver function, and full blood count (FBC) being most frequent.
- Undertesting of HbA1c and albumin:creatinine ratio (ACR) was noted, alongside potential overtesting of lipids, FBC, liver function, and thyroid function.
- Significant variation in testing rates was found between GP practices, with some showing up to 27 times higher rates for specific tests (e.g., HbA1c in CKD patients).
Conclusions:
- Current laboratory testing rates for long-term conditions (LTCs) are not consistently aligned with clinical guidelines.
- Considerable variation in testing practices among GP practices suggests ambiguity in optimal monitoring frequencies.
- Standardizing LTC monitoring based on current evidence is recommended to improve consistency and patient care.
Background:
Use of laboratory testing has increased in the UK over the past few decades, with considerable geographical variation.
Aim:
To evaluate what laboratory tests are used to monitor people with hypertension, type 2 (T2) diabetes, or chronic kidney disease (CKD) and assess variation in test use in UK primary care.
Design & Setting:
Longitudinal cohort study of people registered with UK general practices between June 2013 and May 2018 and previously diagnosed with hypertension, T2 diabetes, or CKD.
Method:
Clinical Practice Research Datalink (CPRD) primary care data linked to ethnic group and deprivation was used to examine testing rates over time, by GP practice, age, sex, ethnic group, and socioeconomic deprivation, with age-sex standardisation.
Results:
Nearly 1 million patients were included, and more than 27 million tests. The most ordered tests were for renal function (1463 per 1000 person-years), liver function (1063 per 1000 person-years), and full blood count (FBC; 996 per 1000 person-years). There was evidence of undertesting (compared with current guidelines) for HbA1c and albumin:creatinine ratio (ACR) or microalbumin, and potential overtesting of lipids, FBC, liver function, and thyroid function. Some GP practices had up to 27 times higher testing rates than others (HbA1c testing among patients with CKD).
Conclusion:
Testing rates are no longer increasing, but they are not always within the guidelines for monitoring long-term conditions (LTCs). There was considerable variation by GP practice, indicating uncertainty over the most appropriate testing frequencies for different conditions. Standardising the monitoring of LTCs based on the latest evidence would provide greater consistency of access to monitoring tests.
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