Education and Clinical Innovation Department, Healthcare Library - Clinical Governance Documentation Centre of the Healthcare Trusts of the Province of Reggio Emilia, Arcispedale Santa Maria Nuova Hospital (IRCCS), Reggio Emilia, Italy.
BMC Health Serv Res. 2012 Jul 3;12:187. doi: 10.1186/1472-6963-12-187.
Systematic reviews have shown that, although well prepared, the Consensus Guidelines have failed to change clinical practice. In the healthcare district of Castelnovo né Monti (Reggio Emilia, Italy), it became necessary for the GPs and Clinical Pathologists to work together to jointly define laboratory profiles.
Observational study with two cycles of retrospective audit on test request forms, in a primary care setting. Objectives of the study were to develop pathology-specific laboratory profiles and to increase the number of provisional diagnoses on laboratory test request forms. A Multiprofessional Multidisciplinary Inter-hospital Work Team developed pathology-specific laboratory profiles for more effective test requesting. After 8 training sessions that used a combined strategy with multifaceted interventions, the 23 General Practitioners (GPs) in the trial district (Castelnovo nè Monti) tested the profiles; the 21 GPs in the Puianello district were the control group; all GPs in both districts participated in the trial. All laboratory tests for both healthcare districts are performed at the Laboratory located in the trial district. A baseline and a 1-year audit were performed in both districts on the GPs' request forms.
Seven pathology-specific laboratory profiles for outpatients were developed. In the year after the first audit cycle: 1) the number of tests requested in the trial district was distinctly lower than that in the previous year, with a decrease of about 5% (p < 0.001); 2) the provisional diagnosis on the request forms was 52.8% in the trial district and 42% in the control district (P < 0.001); 3) the decrease of the number of tests on each request form was much more marked in the trial district (8.73 vs. 10.77; p < 0.001).
The first audit cycle showed a significant decrease in the number of tests ordered only in the trial district. The combined strategy used in this study improved the prescriptive compliance of most of the GPs involved. The presence of the clinical pathologist is seen as an added value.
系统评价表明，尽管共识指南准备充分，但仍未能改变临床实践。在意大利雷焦艾米利亚卡斯泰尔诺沃内蒙蒂（Castelnovo né Monti）的医疗保健区，全科医生和临床病理学家有必要共同合作，共同定义实验室概况。
在初级保健环境中进行了两次回顾性审核的观察性研究。该研究的目的是制定特定于病理学的实验室概况，并增加实验室测试请求表上的临时诊断数量。一个多专业多学科的医院间工作组为更有效的测试请求制定了特定于病理学的实验室概况。在使用多方面干预措施的综合策略进行了 8 次培训会议后，试验区域（卡斯泰尔诺沃内蒙蒂）的 23 名全科医生（GP）测试了这些概况；普亚内洛（Puianello）区的 21 名 GP 为对照组；两个地区的所有 GP 都参加了试验。两个医疗区的所有实验室测试均在位于试验区的实验室进行。在两个地区的 GP 请求表上进行了基线和一年的审核。
为门诊患者制定了 7 种特定于病理学的实验室概况。在第一个审核周期后的一年中：1）试验区的测试请求数量明显低于前一年，减少了约 5%（p < 0.001）；2）试验区请求表上的临时诊断为 52.8%，对照组为 42%（P < 0.001）；3）试验区每个请求表上的测试数量减少更为明显（8.73 与 10.77；p < 0.001）。
第一个审核周期仅在试验区显示出测试数量的显著减少。本研究中使用的综合策略提高了大多数参与的 GP 的规定性依从性。临床病理学家的存在被视为附加值。
