Jones Timothy, Patel Rita, Elwenspoek Martha M C, Watson Jessica C, Mann Ed, Alsop Katharine, Whiting Penny F
The National Institute for Health Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol NHS Foundation Trust, Bristol, UK
Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
BJGP Open. 2023 Mar 21;7(1). doi: 10.3399/BJGPO.2022.0139. Print 2023 Mar.
Use of laboratory testing has increased in the UK over the past few decades, with considerable geographical variation.
To evaluate what laboratory tests are used to monitor people with hypertension, type 2 (T2) diabetes, or chronic kidney disease (CKD) and assess variation in test use in UK primary care.
DESIGN & SETTING: Longitudinal cohort study of people registered with UK general practices between June 2013 and May 2018 and previously diagnosed with hypertension, T2 diabetes, or CKD.
Clinical Practice Research Datalink (CPRD) primary care data linked to ethnic group and deprivation was used to examine testing rates over time, by GP practice, age, sex, ethnic group, and socioeconomic deprivation, with age-sex standardisation.
Nearly 1 million patients were included, and more than 27 million tests. The most ordered tests were for renal function (1463 per 1000 person-years), liver function (1063 per 1000 person-years), and full blood count (FBC; 996 per 1000 person-years). There was evidence of undertesting (compared with current guidelines) for HbA1c and albumin:creatinine ratio (ACR) or microalbumin, and potential overtesting of lipids, FBC, liver function, and thyroid function. Some GP practices had up to 27 times higher testing rates than others (HbA1c testing among patients with CKD).
Testing rates are no longer increasing, but they are not always within the guidelines for monitoring long-term conditions (LTCs). There was considerable variation by GP practice, indicating uncertainty over the most appropriate testing frequencies for different conditions. Standardising the monitoring of LTCs based on the latest evidence would provide greater consistency of access to monitoring tests.
在过去几十年中，英国实验室检测的使用有所增加，且存在显著的地域差异。
评估用于监测高血压、2型（T2）糖尿病或慢性肾脏病（CKD）患者的实验室检测项目，并评估英国初级医疗中检测项目使用情况的差异。
对2013年6月至2018年5月期间在英国全科诊所注册且先前被诊断患有高血压、T2糖尿病或CKD的患者进行纵向队列研究。
利用与种族和贫困程度相关联的临床实践研究数据链（CPRD）初级医疗数据，按全科医生诊所、年龄、性别、种族和社会经济贫困程度，对随时间变化的检测率进行年龄 - 性别标准化检查。
纳入了近100万名患者，进行了超过2700万次检测。最常开具的检测项目是肾功能（每1000人年1463次）、肝功能（每1000人年1063次）和全血细胞计数（FBC；每1000人年996次）。有证据表明糖化血红蛋白（HbA1c）和白蛋白：肌酐比值（ACR）或微量白蛋白检测不足（与现行指南相比），而血脂、FBC、肝功能和甲状腺功能检测可能存在过度。一些全科医生诊所的检测率比其他诊所高出多达27倍（CKD患者中的HbA1c检测）。
检测率不再上升，但并不总是在长期疾病（LTCs）监测指南范围内。全科医生诊所之间存在相当大的差异，表明对于不同病症最合适的检测频率存在不确定性。根据最新证据对LTCs监测进行标准化将使监测检测的获取更加一致。
