Rates of laboratory testing are increasing in the United Kingdom (UK). Half of all tests ordered by General Practitioners (GPs) are to monitor chronic conditions. There is some evidence and guidance on which tests people with chronic diseases should receive and how often they should be tested. However, there is a lot of variability in how GPs request tests to monitor people with chronic conditions such as diabetes, high blood pressure and chronic kidney disease.
There is potential harm from ordering unnecessary tests. If tests are abnormal a doctor may need to do further tests or referrals to find out what is wrong. This can be worrying for patients. Sometimes doctors may never find a cause for abnormal laboratory tests. Unnecessary testing also has a significant impact on GP workload and costs, through review of test results and further investigation of abnormal tests. However, failure to test may lead to missed diagnoses, complications, patient harm and litigation.
This project will use GP records to find tests that have been used for people with one of three common chronic conditions: diabetes, high blood pressure and chronic kidney disease. It will also look at how much GPs vary in how they use these tests and the potential value of carrying out tests not currently recommended by NICE guidelines.
Rates of pathology testing are rising in the UK, with significant geographical variability. Around 50% of overall GP laboratory testing represents monitoring for chronic conditions. While some of this testing is supported by evidence and guidelines, this is not universally the case. As well as being a potential source of waste, overuse of tests for monitoring chronic diseases may be a potential source of harm; causing patient anxiety, reductions in test performance, downstream tests, referrals and overdiagnosis. It also has a significant impact on GP workload and financial costs. On the other hand, failure to test may lead to missed diagnoses, complications, patient harm and litigation.
This study aims to use an open cohort to examine current variation in the use of tests for individuals with type 2 diabetes, hypertension and chronic kidney disease (CKD>2) across the UK. We will consider what tests have been ordered for people with these conditions and look at variation over time, and by region, age, gender, ethnicity and socioeconomic position using agesex-standardised utilisation rates, descriptive statistics and multilevel Poisson regression. We will also consider the potential value of carrying out tests not currently recommended by NICE guidelines, using the example of liver function tests for people with hypertension.
The findings of this study will contribute to developing guidance on what tests should be used to monitor patients with these chronic conditions.
Laboratory tests that have been ordered in patients with type 2 diabetes, hypertension or chronic kidney disease
Frequency of each laboratory test ordered and variation in their use over time and by practice and patient characteristics
Penny Whiting - Chief Investigator - University of Bristol
Martha Elwenspoek - Corresponding Applicant - University of Bristol
- Collaborator -
Jessica Watson - Collaborator - University of Bristol
Katie Charlwood - Collaborator - University of Bristol
Lauren Scott - Collaborator - University of Bristol
Rita Patel - Collaborator - University of Bristol
Thuraiya Al Harthi - Collaborator - University of Bristol
Tim Jones - Collaborator - University of Bristol
William Hollingworth - Collaborator - University of Bristol
Rita Patel - Chief Investigator - University of Bristol
Rachel O'Donnell - Collaborator - University of Bristol
Thuraiya Al Harthi - Collaborator - University of Bristol
Howard Thom - Collaborator - University of Bristol
Lauren Scott - Collaborator - University of Bristol
Martha Elwenspoek - Collaborator - University of Bristol
Rita Patel - Collaborator - University of Bristol
HES Admitted Patient Care;ONS Death Registration Data;Patient Level Index of Multiple Deprivation;Pregnancy Register