O'Sullivan Jack W, Albasri Ali, Nicholson Brian D, Perera Rafael, Aronson Jeffrey K, Roberts Nia, Heneghan Carl
Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Science, University of Oxford, Oxford, UK.
Bodleian Health Care Libraries, University of Oxford, Oxford, UK.
BMJ Open. 2018 Feb 11;8(2):e018557. doi: 10.1136/bmjopen-2017-018557.
Health systems are currently subject to unprecedented financial strains. Inappropriate test use wastes finite health resources (overuse) and delays diagnoses and treatment (underuse). As most patient care is provided in primary care, it represents an ideal setting to mitigate waste.
To identify overuse and underuse of diagnostic tests in primary care.
Systematic review and meta-analysis.
We searched MEDLINE and Embase from January 1999 to October 2017 for studies that measured the inappropriateness of any diagnostic test (measured against a national or international guideline) ordered for adult patients in primary care.
We included 357 171 patients from 63 studies in 15 countries. We extracted 103 measures of inappropriateness (41 underuse and 62 overuse) from included studies for 47 different diagnostic tests.The overall rate of inappropriate diagnostic test ordering varied substantially (0.2%-100%)%).17 tests were underused >50% of the time. Of these, echocardiography (n=4 measures) was consistently underused (between 54% and 89%, n=4). There was large variation in the rate of inappropriate underuse of pulmonary function tests (38%-78%, n=8).Eleven tests were inappropriately overused >50% of the time. Echocardiography was consistently overused (77%-92%), whereas inappropriate overuse of urinary cultures, upper endoscopy and colonoscopy varied widely, from 36% to 77% (n=3), 10%-54% (n=10) and 8%-52% (n=2), respectively.
There is marked variation in the appropriate use of diagnostic tests in primary care. Specifically, the use of echocardiography (both underuse and overuse) is consistently poor. There is substantial variation in the rate of inappropriate underuse of pulmonary function tests and the overuse of upper endoscopy, urinary cultures and colonoscopy.
CRD42016048832.
卫生系统目前正面临前所未有的财政压力。不恰当的检查使用会浪费有限的卫生资源（过度使用），并延误诊断和治疗（使用不足）。由于大多数患者护理是在初级保健中提供的，因此它是减少浪费的理想场所。
确定初级保健中诊断检查的过度使用和使用不足情况。
系统评价和荟萃分析。
我们检索了1999年1月至2017年10月期间的MEDLINE和Embase数据库，以查找测量初级保健中为成年患者开出的任何诊断检查（根据国家或国际指南衡量）不恰当性的研究。
我们纳入了来自15个国家63项研究的357171名患者。我们从纳入研究中提取了针对47种不同诊断检查的103项不恰当性测量指标（41项使用不足和62项过度使用）。诊断检查开出不恰当的总体发生率差异很大（0.2%-100%）。17项检查使用不足的时间超过50%。其中，超声心动图（n=4项测量指标）一直存在使用不足的情况（54%至89%之间，n=4）。肺功能检查使用不足不恰当的发生率差异很大（38%-78%，n=8）。11项检查过度使用不恰当的时间超过50%。超声心动图一直存在过度使用的情况（77%-92%），而尿培养、上消化道内镜检查和结肠镜检查过度使用不恰当的情况差异很大，分别为36%至77%（n=3）、10%-54%（n=10）和8%-52%（n=2）。
初级保健中诊断检查的合理使用存在显著差异。具体而言，超声心动图的使用（包括使用不足和过度使用）一直很差。肺功能检查使用不足不恰当的发生率以及上消化道内镜检查、尿培养和结肠镜检查过度使用的发生率存在很大差异。
CRD42016048832。
