There is a great variation in the use of laboratory tests in Norway, both in general practice and in hospitals. The reasons are only partially known. It is assumed that overconsumption, misconsumption and underconsumption are part of the picture. In 1978, 40 % of consultations in Norway involved laboratory tests, which is a high figure internationally. Recordings from clinical labs show an increase of activity generated by primary care in later years.
The project aim is to enhance critical evaluation of the use of laboratory tests in the clinical process, thereby improving the quality of clinical work, and freeing resources for the individual practice and the community at large.
The key question in the use of laboratory tests is always: How will the result of the analysis benefit the patient?
Other authors have formulated quality aims which have been used in the choice of indicators.
1. A base supply of tests should be available for analysis and use in direct connection with the consultation.
2. The use of a diagnostic test should contribute either to an exact diagnosis or support the use of a specific and effective treatment.
There should ideally be guidelines for the use of a test in diagnostic or control/treatment activity. Such guidelines are largely absent for general practice. The project has pointed out some examples.
3. The service function of the laboratory should be adequate .
There must be routines for the follow up of test results. The patients should find the service acceptable.
These describe the organisation of the laboratory in the practice.
• To what extent are available analyses in the practice in accordance with the Norwegian recommended minimal standard (1991)?
• Is there a written procedure for these analyses?
• Are the procedures known to all employees?
These describe the use of laboratory tests in relation to guidelines:
• Is serum ferritine investigated in pregnancy?
• Is blood HbA1c investigated in diabetes patients ?
• Are serum TSH and serum T4 investigated in hypothyreosis patients?
• Are blood sedimentation rate and CRP investigated simultaneously in patients where the problem is one of infection?
• Is serum chloride used (along with serum potassium)?
describe usefulness for the patient/the practice.
• Is the waiting time for the taking blood test acceptable for the patient?
• Is the practitioner’s plan for reporting back the results of the test clear to the patient?
• Are TSH values within the reference domain in the treatment with thyroxine?
• Are test results outside the reference domain for haemoglobin followed up?
Along with registrations of indicators, the report program produces a survey of laboratory activity and practice activity in the preceding 12 months, related to age groups and sex. A selection of 36 commonly used analyses are included. The report will include the proportion of tests marked as pathological.
The survey enables practitioners to make comparisons between practices of the peer group. The project will generate a pooled database which will produce national figures.
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