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Article

Trends and between-Physician Variation in Laboratory Testing: A Retrospective Longitudinal Study in General Practice

Institute of Primary Care, University and University Hospital Zurich, 8091 Zurich, Switzerland
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Author to whom correspondence should be addressed.
These authors contributed equally to this work.
J. Clin. Med. 2020, 9(6), 1787; https://doi.org/10.3390/jcm9061787
Received: 18 May 2020 / Revised: 5 June 2020 / Accepted: 5 June 2020 / Published: 8 June 2020
(This article belongs to the Section Epidemiology & Public Health)
Laboratory tests are frequently ordered by general practitioners (GPs), but little is known about time trends and between-GP variation of their use. In this retrospective longitudinal study, we analyzed over six million consultations by Swiss GPs during the decade 2009–2018. For 15 commonly used test types, we defined specific laboratory testing rates (sLTR) as the percentage of consultations involving corresponding laboratory testing requests. Patient age- and sex-adjusted time trends of sLTR were modeled with mixed-effect logistic regression accounting for clustering of patients within GPs. We quantified between-GP variation by means of intraclass correlation coefficients (ICC). Nine out of the 15 laboratory test types considered showed significant temporal increases, most eminently vitamin D (ten-year odds ratio (OR) 1.88, 95% confidence interval (CI) 1.71–2.06) and glycated hemoglobin (ten-year OR 1.87, 95% CI 1.82–1.92). Test types both subject to substantial increase and high between-GP variation of sLTR were vitamin D (ICC 0.075), glycated hemoglobin (ICC 0.101), C-reactive protein (ICC 0.202), and vitamin B12 (ICC 0.166). Increasing testing frequencies and large between-GP variation of specific test type use pointed at inconsistencies of medical practice and potential overuse. View Full-Text
Keywords: laboratory testing; trend; general practice; mixed-effect model; intraclass correlation coefficient laboratory testing; trend; general practice; mixed-effect model; intraclass correlation coefficient
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MDPI and ACS Style

Schumacher, L.D.; Jäger, L.; Meier, R.; Rachamin, Y.; Senn, O.; Rosemann, T.; Markun, S. Trends and between-Physician Variation in Laboratory Testing: A Retrospective Longitudinal Study in General Practice. J. Clin. Med. 2020, 9, 1787. https://doi.org/10.3390/jcm9061787

AMA Style

Schumacher LD, Jäger L, Meier R, Rachamin Y, Senn O, Rosemann T, Markun S. Trends and between-Physician Variation in Laboratory Testing: A Retrospective Longitudinal Study in General Practice. Journal of Clinical Medicine. 2020; 9(6):1787. https://doi.org/10.3390/jcm9061787

Chicago/Turabian Style

Schumacher, Lisa D., Levy Jäger, Rahel Meier, Yael Rachamin, Oliver Senn, Thomas Rosemann, and Stefan Markun. 2020. "Trends and between-Physician Variation in Laboratory Testing: A Retrospective Longitudinal Study in General Practice" Journal of Clinical Medicine 9, no. 6: 1787. https://doi.org/10.3390/jcm9061787

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