Smellie W S A, Clark G, McNulty C A M
Clinical Laboratory, General Hospital, Cockton Hill Road, Bishop Auckland, County Durham DL14 6AD, UK.
J Clin Pathol. 2003 Dec;56(12):933-6. doi: 10.1136/jcp.56.12.933.
To compare differences in microbiology testing activity between general practices within and between five hospitals in two National Health Service (NHS) regions in England.
Retrospective capture of standardised microbiology testing activity from the laboratory computer databases. Six equivalent tests were identified and compared. Data were obtained for 174 general practices in eight primary care groups, served by two NHS hospital trusts and three public health laboratories. The total catchment population was 1,180,000 people. Comparative test activities were displayed graphically and differences in median test activity and the hospital activity distributions were examined by the Wilcoxon signed rank test.
Median testing activity differed by 200% (urine) to 800% (wound swabs) between the trusts that performed the highest and the lowest number of tests, and from 300% to 1900% between the top and bottom 10% activity bands of general practices. Large and significant differences were found between the hospitals, irrespective of whether they belonged to the same trust, and irrespective of their geographical location.
Large differences in microbiology testing exist within individual trust catchment areas in primary care, and there are also considerable differences between trusts. These inequalities may also introduce a selection bias into epidemiological and antibiotic resistance surveillance. This indicates a widespread need to examine and deal with the reasons responsible for these differences.
比较英格兰两个国民医疗服务体系（NHS）地区五家医院内部及之间的全科医疗中微生物检测活动的差异。
从实验室计算机数据库中回顾性获取标准化微生物检测活动数据。确定并比较六项等效检测。获取了由两个NHS医院信托机构和三个公共卫生实验室服务的八个初级保健组中174家全科医疗的数据。总服务人口为118万人。以图表形式展示比较检测活动，并通过Wilcoxon符号秩检验检查中位检测活动和医院活动分布的差异。
进行检测数量最多和最少的信托机构之间，中位检测活动差异为200%（尿液）至800%（伤口拭子），全科医疗中活动最高和最低的10%区间之间差异为300%至1900%。无论医院是否属于同一信托机构，也无论其地理位置如何，各医院之间均存在巨大且显著的差异。
在初级保健中，各个信托机构服务区域内微生物检测存在巨大差异，信托机构之间也存在相当大的差异。这些不平等现象还可能在流行病学和抗生素耐药性监测中引入选择偏倚。这表明广泛需要审视并处理造成这些差异的原因。
