Salvagno Gian Luca, Lippi Giuseppe, Targher Giovanni, Montagnana Martina, Guidi Gian Cesare
Sezione di Chimica Clinica, Dipartimento di Scienze Morfologico-Biomediche, Università degli Studi di Verona, Verona, Italy.
Clin Chem Lab Med. 2007;45(8):1065-7. doi: 10.1515/CCLM.2007.195.
Regardless of the available recommendations to perform glycated haemoglobin testing at a 2- to 3-month frequency, there is increasing evidence of an inappropriate laboratory use of this test in clinical practice.
Data from our Laboratory Information System were analysed for glycated haemoglobin test orders over a 3-year period using Microsoft Excel to calculate the order intervals and the test frequency for each patient. To assess the appropriateness of repeat testing, only data for patients who had at least two separate glycated haemoglobin test results were included in the analysis. Inappropriate test orders were defined as any order for a given patient taking place within a 29- or 89-day period following the previous order.
The results of our investigation demonstrate that inappropriate laboratory utilisation of this test is commonplace (26% of total repeat orders within 90 days), especially for inpatients (63.7% of inpatient repeat orders in less than 90 days). When stratifying glycated haemoglobin test results according to the >7% threshold, the frequency of inappropriate laboratory use (>90 days) was surprisingly greater among inpatients with a previous value of <7% than among those with a previous value of >7% (57.6% vs. 42.4%). The frequency of inappropriate glycated haemoglobin repeat test orders was lower among outpatients with a previous value of <7% than in outpatients with a previous value of >7% (64.8% vs. 35.2%).
We conclude that more accurate application of the current recommendations would be advisable to decrease unnecessary testing and prevent avoidable health expenditure.
尽管有建议称糖化血红蛋白检测应每2至3个月进行一次，但越来越多的证据表明，在临床实践中该检测在实验室的使用存在不当之处。
使用Microsoft Excel分析我们实验室信息系统中3年内糖化血红蛋白检测订单的数据，以计算每个患者的订单间隔和检测频率。为评估重复检测的合理性，分析仅纳入至少有两次独立糖化血红蛋白检测结果的患者数据。不当检测订单定义为给定患者在上次订单后的29天或89天内进行的任何订单。
我们的调查结果表明，该检测在实验室的不当使用很常见（90天内的重复订单占总重复订单的26%），尤其是住院患者（90天内住院患者的重复订单占63.7%）。根据>7%的阈值对糖化血红蛋白检测结果进行分层时，先前值<7%的住院患者中不当实验室使用（>90天）的频率出人意料地高于先前值>7%的患者（57.6%对42.4%）。先前值<7%的门诊患者中糖化血红蛋白重复检测订单的频率低于先前值>7%的门诊患者（64.8%对35.2%）。
我们得出结论，建议更准确地应用当前建议，以减少不必要的检测并防止可避免的医疗支出。
