Hartley R M, Charlton J R, Harris C M, Jarman B
Br Med J (Clin Res Ed). 1984 Sep 22;289(6447):735-8. doi: 10.1136/bmj.289.6447.735.
Information regarding all consultations was collected in seven general practices for one year. From these data we report on the use of laboratory tests and its association with patient characteristics--including social class, age, sex, and diagnosis--and with which doctor was consulted. Most of the requests were for technically simple tests of low cost. There was a noticeable variation in the use of tests with regard to all patient characteristics. Diagnosis, identity of doctor, age of patient, and social class were each shown by multivariate techniques to be independently related to use of tests. Whereas fewer tests were used per consultation for social classes III-V compared with other social classes, more were used per patient per year for these same groups, reflecting in part the higher consultation rates of social classes III-V. Variation in diagnoses fully accounted for the greater test ordering for women. Nearly two thirds of all tests were ordered for 10% of all patients who consulted and 7% of all registered patients. The results of our analysis suggest that this concentration is determined primarily by those patient characteristics most indicative of medical need and by which doctor is providing care.
我们在七家普通诊所收集了为期一年的所有会诊信息。根据这些数据，我们报告了实验室检查的使用情况及其与患者特征（包括社会阶层、年龄、性别和诊断结果）的关联，以及会诊医生的情况。大多数检查申请是针对技术上简单且成本低廉的检查。在所有患者特征方面，检查的使用存在明显差异。多变量技术显示，诊断结果、医生身份、患者年龄和社会阶层均与检查的使用独立相关。与其他社会阶层相比，III - V 社会阶层每次会诊的检查使用较少，但这些群体每年每位患者的检查使用更多，这部分反映了 III - V 社会阶层较高的会诊率。诊断结果的差异完全解释了女性检查申请较多的原因。几乎三分之二的检查是为所有会诊患者中的 10% 和所有注册患者中的 7% 开出的。我们的分析结果表明，这种集中情况主要由那些最能表明医疗需求的患者特征以及提供治疗的医生决定。
