Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia.
Graduate School of Health, University of Technology Sydney, Sydney, New South Wales, Australia.
BMJ Open. 2018 Nov 13;8(11):e024223. doi: 10.1136/bmjopen-2018-024223.
In Australia, general practitioners usually are the first point of contact for patients with non-urgent medical conditions. Appropriate and efficient utilisation of pathology tests by general practitioners forms a key part of diagnosis and monitoring. However overutilisationand underutilisation of pathology tests have been reported across several tests and conditions, despite evidence-based guidelines outlining best practice in pathology testing. There are a limited number of studies evaluating the impact of these guidelines on pathology testing in general practice. The aim of our quantitative observational study is to define how pathology tests are used in general practice and investigate how test ordering practices align with evidence-based pathology guidelines.
Access to non-identifiable patient data will be obtained through electronic health records from general practices across three primary health networks in Victoria, Australia. Numbers and characteristics of patients, general practices, encounters, pathology tests and problems managed over time will be described. Overall rates of encounters and tests, alongside more detailed investigation between subcategories (encounter year, patient's age, gender, and location and general practice size), will also be undertaken. To evaluate how general practitioner test ordering coincides with evidence-based guidelines, five key candidate indicators will be investigated: full blood counts for patients on clozapine medication; international normalised ratio measurements for patients on warfarin medication; glycated haemoglobin testing for monitoring patients with diabetes; vitamin D testing; and thyroid function testing.
Ethics clearance to collect data from general practice facilities has been obtained by the data provider from the RACGP National Research and Evaluation Ethics Committee (NREEC 17-008). Approval for the research group to use these data has been obtained from Macquarie University (5201700872). This study is funded by the Australian Government Department of Health Quality Use of Pathology Program (Agreement ID: 4-2QFVW4M). Findings will be reported to the Department of Health and disseminated in peer-reviewed academic journals and presentations (national and international conferences, industry forums).
在澳大利亚，全科医生通常是患有非紧急医疗状况的患者的第一接触点。全科医生对病理检查的合理和有效利用是诊断和监测的关键部分。然而，尽管有循证指南概述了病理检查的最佳实践，但仍有报道称，在几种检查和情况下，病理检查存在过度使用和使用不足的情况。评估这些指南对全科实践中病理检查影响的研究数量有限。我们的定量观察性研究旨在定义病理检查在全科实践中的使用方式，并调查检验医嘱与基于证据的病理检查指南的一致性。
通过澳大利亚维多利亚州三个初级保健网络中的全科医生的电子健康记录，获取无法识别患者数据。将描述患者、全科医生、就诊、病理检查和随时间推移管理的问题的数量和特征。还将进行总体就诊和检查率，以及亚组（就诊年份、患者年龄、性别、地点和全科医生规模）之间的更详细调查。为了评估全科医生检验医嘱与基于证据的指南的一致性，将研究五个关键候选指标：氯氮平药物治疗患者的全血细胞计数；华法林药物治疗患者的国际标准化比值测量；监测糖尿病患者的糖化血红蛋白检测；维生素 D 检测；甲状腺功能检测。
数据提供者已通过 RACGP 国家研究和评估伦理委员会（NREEC 17-008）从全科医生设施获得了收集数据的伦理许可。麦考瑞大学已批准研究小组使用这些数据（5201700872）。本研究由澳大利亚政府卫生部质量病理检查使用计划（协议 ID：4-2QFVW4M）资助。研究结果将向卫生部报告，并在同行评议的学术期刊和演讲（国家和国际会议、行业论坛）中传播。
