A STRATEGY TO PROMOTE RATIONAL CLINICAL-CHEMISTRY TEST UTILIZATION

There is abundant evidence that clinical chemistry laboratory tests ar e over-ordered in North America, but there does not seem to be an effe ctive corrective strategy that has a prolonged effect, The goal of thi s study was to design one that had a prolonged effect. Using a pre- an d post-intervention survey study design, the authors observed the effe ct of physician education followed by a ban on test-panel ordering of common clinical chemistry tests, reinforced by written reminders to ph ysicians not heeding the ban, on ordering patterns (tests per specimen ), and total numbers of these tests ordered. Panels of >16 common bioc hemistry tests per specimen were reduced from 15% to 6% of orders for inpatients and from 44% to 11% for outpatients 1 year after the implem entation of the ban on test-panel ordering, However, the ban had littl e effect on the ordering rates for panels of 7 common tests, Education al exercises (newsletters and lectures) had no effect. The authors con clude that a ban on test-panel (profile) ordering reinforced by contin uing reminders to nonconforming physicians is an effective means of re ducing clinical chemistry test usage over the long term, A 38% reducti on of common biochemistry tests ordered was achieved, However, overall costs savings were modest, Nevertheless, the authors conclude that th e cost-effective use of the clinical pathology laboratory by careful s election of tests is an essential part of a medical trainee's educatio n.