Effect of enhanced feedback and brief educational reminder messages on laboratory test requesting in primary care: a cluster randomised trial

From the June 17 issue of The Lancet: [registration required]

Ruth E Thomas, Bernard Lewis Croal,, Craig Ramsay, Martin Eccles and Jeremy Grimshaw. Effect of enhanced feedback and brief educational reminder messages on laboratory test requesting in primary care: a cluster randomised trial. The Lancet 2006; 367:1990-1996.

Background: Laboratory services play an important part in screening, diagnosis, and management of patients within primary care. However, unnecessary use of laboratory tests is increasing. Our aim was to assess the effect of two interventions on the number of laboratory tests requested by primary-care physicians.
 

Methods: We did a cluster randomised controlled trial using a 2×2 factorial design, involving 85 primary-care practices (370 family practitioners) that request all laboratory tests from one regional centre. The interventions were quarterly feedback of practice requesting rates for nine laboratory tests, enhanced with educational messages, and brief educational reminder messages added to the test result reports for nine laboratory tests. The primary outcome was the number of targeted tests requested by primary-care practices during the 12 months of the intervention. This study is registered as an International Standard Randomised Controlled Trial, number ISRCTN06490422.
 

Findings: Practices that received either or both the enhanced feedback and the reminder messages were significantly less likely than the control group to request the targeted tests in total (enhanced feedback odds ratio 0·87, 95% CI 0·81–0·94; reminder messages 0·89, 0·83–0·93). The effect of the interventions varied across the targeted tests individually, although the number of tests requested for both interventions was generally reduced. Neither intervention was consistently better than the other.
 

Interpretation: Enhanced feedback of requesting rates and brief educational reminder messages, alone and in combination, are effective strategies for reducing test requesting in primary care. Both strategies are feasible within most laboratory settings.

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