Alshekhabobakr Hafsa Mohammed, AlSaqatri Salim O, Rizk Nasser Moustafa
Biomedical Sciences Department, College of Health Sciences, QU Health, Qatar University, Doha, Qatar.
Community College of Qatar, Doha, Qatar.
J Multidiscip Healthc. 2022 Mar 3;15:413-429. doi: 10.2147/JMDH.S320545. eCollection 2022.
The use of diagnostic laboratory tests is increasing worldwide. Improper test utilization (ITU) is a common problem for all healthcare systems as it costs substantial expenses for the health systems and impacts optimal patient care.
The present small-scale survey aims to highlight the current practice of ITU among the labs and physicians, and investigate the actions of diagnostic laboratories towards ITU, and identify the reasons affecting test ordering decisions among physicians.
A cross sectional study based on two different surveys was developed and distributed from March 2017 to April 2017 to laboratory supervisors and physicians (clinicians) at Hamad Medical Corporation (HMC), Qatar. Fourteen laboratory supervisors and eighty-nine physicians were surveyed about improper test utilization practices. The overall results are descriptive data.
The overall proportion of improperly utilized tests detected by the laboratory supervisors were 50.0%, 35.7%, and 14.3% for overused, misused, and underused lab tests, respectively. Among the physicians, 91% used the electronic ordering template to select the appropriate tests. Moreover, 78.7% of the physicians used the clinical guidelines, while 73% were not employing the laboratory handbook. Furthermore, 95.5%% of the physicians preferred to get feedback about inappropriate tests, while 51.1% were not receiving any, and 40.9% were rarely receiving. Finally, 67.4% were unaware of the tests' costs among surveyed physicians, and 63.6% showed a willingness to reduce their orders if the cost was high and unnecessary.
The physician's and the laboratories' communication were inadequate and not systematized, causing ITU practices. The improvement strategy should focus on the communication between clinical labs and physicians and enhance physician implementation to order appropriate lab tests. This could be achieved by conducting legitimate educational methodologies, continuous feedback reviews, ongoing audits, executing health information technology instruments, engaging laboratory practice guidelines, and applying demand management and testing algorithms.
诊断实验室检测在全球范围内的使用正在增加。不当检测利用（ITU）是所有医疗保健系统普遍存在的问题，因为它给卫生系统带来了巨大成本，并影响患者的最佳护理。
本次小规模调查旨在突出实验室和医生中ITU的当前做法，调查诊断实验室针对ITU采取的行动，并确定影响医生检测医嘱决策的原因。
基于两项不同调查开展了一项横断面研究，并于2017年3月至2017年4月分发给卡塔尔哈马德医疗公司（HMC）的实验室主管和医生（临床医生）。就不当检测利用做法对14名实验室主管和89名医生进行了调查。总体结果为描述性数据。
实验室主管检测到的不当利用检测的总体比例中，过度使用、滥用和使用不足的实验室检测分别为50.0%、35.7%和14.3%。在医生中，91%使用电子医嘱模板来选择合适的检测。此外，78.7%的医生使用临床指南，而73%未使用实验室手册。此外，95.5%的医生希望得到关于不适当检测的反馈，而51.1%未收到任何反馈，40.9%很少收到反馈。最后，在接受调查的医生中，67.4%不知道检测费用，63.6%表示如果费用高昂且不必要，愿意减少检测医嘱。
医生与实验室之间的沟通不足且未系统化，导致了ITU行为。改进策略应侧重于临床实验室与医生之间的沟通，并加强医生下达适当实验室检测医嘱的执行情况。这可以通过开展合理的教育方法、持续的反馈审查、持续的审核、执行健康信息技术工具、采用实验室实践指南以及应用需求管理和检测算法来实现。
