دورية أكاديمية
Inappropriate requesting of glycated hemoglobin (Hb A1c) is widespread: assessment of prevalence, impact of national guidance, and practice-to-practice variability.
| العنوان: | Inappropriate requesting of glycated hemoglobin (Hb A1c) is widespread: assessment of prevalence, impact of national guidance, and practice-to-practice variability. |
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| المؤلفون: | Driskell OJ; Department of Clinical Biochemistry, Keele University School of Medicine, University Hospital of North Staffordshire, Stoke-on-Trent, UK., Holland D, Hanna FW, Jones PW, Pemberton RJ, Tran M, Fryer AA |
| المصدر: | Clinical chemistry [Clin Chem] 2012 May; Vol. 58 (5), pp. 906-15. Date of Electronic Publication: 2012 Feb 16. |
| نوع المنشور: | Journal Article; Research Support, Non-U.S. Gov't |
| اللغة: | English |
| بيانات الدورية: | Publisher: Oxford University Press Country of Publication: England NLM ID: 9421549 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1530-8561 (Electronic) Linking ISSN: 00099147 NLM ISO Abbreviation: Clin Chem Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: 2020- : Oxford : Oxford University Press Original Publication: Baltimore, Md. : P.B. Hoeber, [c1955- |
| مواضيع طبية MeSH: | Practice Guidelines as Topic* , Quality Assurance, Health Care*, General Practice/*statistics & numerical data , Glycated Hemoglobin/*analysis , Practice Patterns, Physicians'/*statistics & numerical data, Diabetes Mellitus/diagnosis ; Female ; General Practice/standards ; Guideline Adherence ; Humans ; Longitudinal Studies ; Male ; Practice Patterns, Physicians'/standards ; Primary Health Care/standards ; Primary Health Care/statistics & numerical data |
| مستخلص: | Background: Estimates suggest that approximately 25% of requests for pathology tests are unnecessary. Even in diabetes, for which international guidance provides recommended testing frequency, considerable variability in requesting practice exists. Using the diabetes marker, Hb A(1c), we examined (a) the prevalence of under- and overrequesting, (b) the impact of international guidance on prevalence, and (c) practice-to-practice variability. Methods: We examined Hb A(1c) requests (519 664 requests from 115 730 patients, January 2001 to March 2011) processed by the Clinical Biochemistry Department, University Hospital of North Staffordshire, and prevalence of requesting outside guidance from intervals between requests was calculated. Requests were classified as "appropriate," "too soon," or "too late." We also assessed the effect of demographic factors and publication of guidance, along with between-practice variability, on prevalence. Results: Only 49% of requests conformed to guidance; 21% were too soon and 30% were too late. Underrequesting was more common in primary care, in female patients, in younger patients, and in patients with generally poorer control (all P < 0.001); the reverse generally was true for overrequesting. Publication of guidance (e.g., American Diabetes Association, UK National Institute for Health and Clinical Excellence) had no significant impact on under- or overrequesting rates. Prevalence of inappropriate requests varied approximately 6-fold between general practices. Conclusions: Although overrequesting was common, underrequesting was more prevalent, potentially affecting longer-term health outcomes. National guidance appears to be an ineffective approach to changing request behavior, supporting the need for a multisystem approach to reducing variability. |
| معلومات مُعتمدة: | HCS/08/011 United Kingdom DH_ Department of Health |
| المشرفين على المادة: | 0 (Glycated Hemoglobin A) |
| تواريخ الأحداث: | Date Created: 20120221 Date Completed: 20120705 Latest Revision: 20221207 |
| رمز التحديث: | 20231215 |
| DOI: | 10.1373/clinchem.2011.176487 |
| PMID: | 22344287 |
| قاعدة البيانات: | MEDLINE |
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