Evaluation of pathology ordering by general practitioners in Australia

Abstract

This thesis describes and evaluates pathology test ordering by general practitioners (GPs) in Australia, using data collected in the BEACH program (2000-2010). From 2000-02 to 2006-08, the total increase in volume of GP-ordered pathology tests was due to: increased likelihood of GPs’ ordering test(s), increased number of tests ordered per episode, increased number of problems managed at encounters, and increased population attendance rates. Significant independent predictors of the volume of pathology ordered by GPs were investigated. The principal explanatory variable was the type of problem being managed. For six problems, appropriateness of ordering was assessed, by measuring alignment of GPs’ ordering with guidance documents. Alignment was good for: hypertension, Type 2 diabetes, lipid disorders and weakness/tiredness; and poor for ‘health checks’ and overweight/obesity. Of the total volume of tests for these problems, only a small proportion was deemed inappropriate. I found no evidence to support concerns raised in the literature about widespread inappropriate ordering. For the ongoing management of chronic problems, pathology testing guidance was poor. Australia has an ageing population and therefore chronic problem management, and the testing associated with it, will inevitably increase. Improved pathology guidance could help support GPs’ to order appropriately in this high growth area.