It is time to focus on reducing inappropriate test ordering
The complexity of modern medicine has promoted an excessive reliance on the results of empirical tests rather than clinical acumen. In Australia, this is reflected in the fact that the rise in the costs of diagnostic testing in pathology and radiology is second only to the rise in cost of pharmaceutical prescriptions, the fastest-growing sector in our healthcare budget.
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- 1. Williams SV, Eisenberg JM, Pascale LA, Kitz DS. Physicians' perceptions about unnecessary diagnostic testing. Inquiry 1982, 19: 363-370.
- 2. Gortmaker SL, Bickford AF, Mathewson HO, et al. A successful experiment to reduce unnecessary laboratory use in a community hospital. Med Care 1988; 26: 631-642.
- 3. Axt-Adam P, van der Wouden JC, van der Does E. Influencing behaviour of physicians ordering laboratory tests: a literature study. Med Care 1998; 31: 784-794.
- 4. Stuart PJ, Crooks S, Porton M. An interventional program for diagnostic testing in the emergency department. Med J Aust 2002; 177: 131-134. <MJA full text>
- 5. Plapp FV, Essmyer CE, Byrd AB, Zucker ML. How to successfully influence laboratory test utilisation. Clin Leadersh Manag Rev 2000; 14: 253-260.
- 6. Solomon DH, Hashimoto H, Daltroy L, Liang MH. Techniques to improve physicians' use of diagnostic tests — a new conceptual framework. JAMA 1998; 280: 2020-2027.
- 7. Moskowitz MA. Evaluating doctors' office testing patterns. Clin Lab Med 1986; 6: 387-394.
- 8. Van Walraven C, Goel V, Chan B. Towards optimal laboratory use: effect of population based interventions on laboratory utilisation — a time series analysis. JAMA 1998; 280: 2028-2033.
- 9. Lundberg GD. Changing physician behaviour in ordering diagnostic tests. JAMA 1998; 280: 2036.
- 10. Isouard G. A quality management intervention to improve clinical laboratory use in acute myocardial infarction. Med J Aust 1999; 170: 11-14. <http://www.mja.com.au/public/issues/jan4/isouard/isouard.html>
Both authors are participating in the "Rational investigation ordering" Breakthrough Collaborative sponsored by the National Institute of Clinical Studies. R J H H is the Chairman of the Breakthrough Collaborative.