NHS 全科医生实验室检测的时间增长和地域差异：利用常规数据确定研究重点。
Temporal growth and geographic variation in the use of laboratory tests by NHS general practices: using routine data to identify research priorities.
机构信息
School of Social and Community Medicine, University of Bristol, Bristol, UK.
出版信息
Br J Gen Pract. 2013 Apr;63(609):e256-66. doi: 10.3399/bjgp13X665224.
BACKGROUND
Laboratory tests are extensively used for diagnosis and monitoring in UK primary care. Test usage by GPs, and associated costs, have grown substantially in recent years.
AIM
This study aimed to quantify temporal growth and geographic variation in utilisation of laboratory tests.
DESIGN AND SETTING
Retrospective cohort study using data from general practices in the UK.
METHOD
Data from the General Practice Research Database, including patient demographics, clinical details, and laboratory test results, were used to estimate rates of change in utilisation between 2005 and 2009, and identify tests with greatest inter-regional variation, by fitting random-effects Poisson regression models. The study also investigated indications for test requests, using diagnoses and symptoms recorded in the 2 weeks before each test.
RESULTS
Around 660 000 tests were recorded in 230 000 person-years of follow-up. Test use increased by 24.2%, from 23 872 to 29 644 tests per 10 000 person-years, between 2005 and 2009. Tests with the largest increases were faecal occult blood (121%) and C-reactive protein (86%). There was substantial geographic variation in test utilisation; GPs in some regions requested tests such as plasma viscosity and cardiac enzymes at a rate more than three times the national average.
CONCLUSION
Increases in the use of laboratory tests have substantial resource implications. Rapid increases in particular tests may be supported by evidence-based guidelines, but these are often vague about who should be tested, how often, and for how long. Substantial regional variation in test use may reflect uncertainty about diagnostic accuracy and appropriate indications for the laboratory test. There is a need for further research on the diagnostic accuracy, therapeutic impact, and effect on patient health outcomes of the most rapidly increasing and geographically variable tests.
背景
在英国初级保健中，实验室检测被广泛用于诊断和监测。近年来，全科医生（GP）对检测的使用及其相关成本大幅增长。
目的
本研究旨在量化实验室检测的使用量随时间的增长和地域差异。
设计和设置
这是一项使用英国普通实践数据的回顾性队列研究。
方法
使用来自一般实践研究数据库的数据，包括患者人口统计学、临床细节和实验室检测结果，通过拟合随机效应泊松回归模型，估计 2005 年至 2009 年期间使用率的变化率，并确定具有最大区域间差异的检测。该研究还通过在每次检测前两周记录的诊断和症状，调查检测请求的原因。
结果
在 230000 人年的随访中，共记录了约 660000 次检测。2005 年至 2009 年间，检测使用量增加了 24.2%，从 23872 次增加到 29644 次/10000 人年。增长幅度最大的检测是粪便潜血（121%）和 C 反应蛋白（86%）。检测使用率存在显著的地域差异；一些地区的全科医生请求检测的频率，如血浆黏度和心肌酶，是全国平均水平的三倍以上。
结论
实验室检测的使用增加对资源有重大影响。某些检测的快速增长可能得到基于证据的指南的支持，但这些指南通常对谁应该进行检测、检测频率和时间长短没有明确的规定。检测使用的显著地域差异可能反映了对诊断准确性和实验室检测适用指征的不确定性。需要进一步研究这些增长最快和地域差异最大的检测的诊断准确性、治疗效果以及对患者健康结果的影响。
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