Benchmarking general practice use of pathology services: a model for monitoring change

Aims-To identify a model to assess general practitioner use of pathology se rvices that could be applied to assess specific interventions designed to p romote best practice. Methods-A database containing standardised requesting data for 22 general p ractices was constructed. The database contained 28 tests covering 95% of g eneral practitioner activity, distributed across pathology, and it was eval uated during two sequential six month periods. A comparison of ranks of req uesting activity between different time periods was undertaken by calculati ng Pearson rank correlation coefficients. Requesting numbers were also adju sted for patients' age and sex distributions within the 22 practices for a sample of three high volume tests. The effects of distributing requesting g uidelines and details of requesting activity were assessed during two seque ntial three month periods. Results-Requesting activity was extremely stable during the two baseline pe riods for most tests (r > 0.80 for 20 of the 28 tests). Several less discri minatory tests were identified. Age and sex adjustment had minimal impact o n the ranks of requesting activity. Requesting activity during the two thre e month periods after distributing guidelines and comparative details of in dividual requesting activity showed little change (overall correlation coef ficient, 0.844 between baseline and intervention periods). Conclusion-Ranking general practitioners requesting activity adjusted for p ractice list size provides a reproducible means of measuring requesting act ivity for most pathology tests performed in general practice. Activity was not influenced by age or sex of patients on the practice list. Distributing requesting guidelines and individual requesting activity on their own do n ot have any measurable impact on requesting activity. More innovative (poss ibly multiple) interventions might be required to influence general practit ioner requesting practice.