Efficiency over thoroughness in laboratory testing decision-making in primary care: findings from a realist review
<p><strong>Background:</strong> Existing research demonstrates significant variation in test-ordering practice, and growth in the use of laboratory tests in primary care. Reviews of interventions designed to change test ordering practice report heterogeneity in design and effective...
| Main Authors: | , |
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| Format: | Journal article |
| Language: | English |
| Published: |
Royal College of General Practitioners
2020
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| _version_ | 1826269150815715328 |
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| author | Duddy, C Wong, G |
| author_facet | Duddy, C Wong, G |
| author_sort | Duddy, C |
| collection | OXFORD |
| description | <p><strong>Background:</strong> Existing research demonstrates significant variation in test-ordering practice, and growth in the use of laboratory tests in primary care. Reviews of interventions designed to change test ordering practice report heterogeneity in design and effectiveness. Improving understanding of clinicians’ decision making in relation to laboratory testing is an important means of understanding practice patterns and developing theory-informed interventions.</p>
<p><strong>Aim:</strong> To develop explanations for the underlying causes of patterns of variation and increasing
use of laboratory tests in primary care and make recommendations for future research and intervention design.</p>
<p><strong>Design and setting:</strong> Realist review of secondary data from primary care.</p>
<p><strong>Method:</strong> Diverse evidence including data from qualitative and quantitative studies was gathered via
systematic and iterative searching processes. Data was synthesised according to realist principles to develop explanations accounting for clinicians’ decision-making in relation to laboratory tests.</p>
<p><strong>Results:</strong> 145 documents contributed data to the synthesis. Laboratory test ordering can fulfil many
roles in primary care. Decisions about tests are incorporated into practice heuristics and tests are deployed as a tool to manage patient interactions. Ordering tests may be easier
than not ordering tests in existing systems. Alongside high workloads and limited time to devote to decision-making, there is a common perception that laboratory tests are relatively
inconsequential interventions. Clinicians prioritise efficiency over thoroughness in decision making about laboratory tests.</p>
<p><strong>Conclusions:</strong> Interventions to change test-ordering practice can be understood as aiming to preserve
efficiency or encourage thoroughness in decision-making. Intervention designs and evaluations should consider how testing decisions are made in real-world clinical practice.</p> |
| first_indexed | 2024-03-06T21:20:34Z |
| format | Journal article |
| id | oxford-uuid:414dfb8b-ccfe-4480-850c-9b5a8459db58 |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-06T21:20:34Z |
| publishDate | 2020 |
| publisher | Royal College of General Practitioners |
| record_format | dspace |
| spelling | oxford-uuid:414dfb8b-ccfe-4480-850c-9b5a8459db582022-03-26T14:42:52ZEfficiency over thoroughness in laboratory testing decision-making in primary care: findings from a realist reviewJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:414dfb8b-ccfe-4480-850c-9b5a8459db58EnglishSymplectic ElementsRoyal College of General Practitioners2020Duddy, CWong, G<p><strong>Background:</strong> Existing research demonstrates significant variation in test-ordering practice, and growth in the use of laboratory tests in primary care. Reviews of interventions designed to change test ordering practice report heterogeneity in design and effectiveness. Improving understanding of clinicians’ decision making in relation to laboratory testing is an important means of understanding practice patterns and developing theory-informed interventions.</p> <p><strong>Aim:</strong> To develop explanations for the underlying causes of patterns of variation and increasing use of laboratory tests in primary care and make recommendations for future research and intervention design.</p> <p><strong>Design and setting:</strong> Realist review of secondary data from primary care.</p> <p><strong>Method:</strong> Diverse evidence including data from qualitative and quantitative studies was gathered via systematic and iterative searching processes. Data was synthesised according to realist principles to develop explanations accounting for clinicians’ decision-making in relation to laboratory tests.</p> <p><strong>Results:</strong> 145 documents contributed data to the synthesis. Laboratory test ordering can fulfil many roles in primary care. Decisions about tests are incorporated into practice heuristics and tests are deployed as a tool to manage patient interactions. Ordering tests may be easier than not ordering tests in existing systems. Alongside high workloads and limited time to devote to decision-making, there is a common perception that laboratory tests are relatively inconsequential interventions. Clinicians prioritise efficiency over thoroughness in decision making about laboratory tests.</p> <p><strong>Conclusions:</strong> Interventions to change test-ordering practice can be understood as aiming to preserve efficiency or encourage thoroughness in decision-making. Intervention designs and evaluations should consider how testing decisions are made in real-world clinical practice.</p> |
| spellingShingle | Duddy, C Wong, G Efficiency over thoroughness in laboratory testing decision-making in primary care: findings from a realist review |
| title | Efficiency over thoroughness in laboratory testing decision-making in primary care: findings from a realist review |
| title_full | Efficiency over thoroughness in laboratory testing decision-making in primary care: findings from a realist review |
| title_fullStr | Efficiency over thoroughness in laboratory testing decision-making in primary care: findings from a realist review |
| title_full_unstemmed | Efficiency over thoroughness in laboratory testing decision-making in primary care: findings from a realist review |
| title_short | Efficiency over thoroughness in laboratory testing decision-making in primary care: findings from a realist review |
| title_sort | efficiency over thoroughness in laboratory testing decision making in primary care findings from a realist review |
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