Effect of enhanced feedback and brief educational reminder messages on laboratory test requesting in primary care: a cluster randomised trial

Ruth Elizabeth Thomas, Bernard Lewis Croal, Craig R Ramsay, M. P. Eccles, J. M. Grimshaw

Research output: Contribution to journalArticle

67 Citations (Scopus)

Abstract

Background
Laboratory services play an important part in screening, diagnosis, and management of patients within primary care. However, unnecessary use of laboratory tests is increasing. Our aim was to assess the effect of two interventions on the number of laboratory tests requested by primary-care physicians.
Methods
We did a cluster randomised controlled trial using a 2×2 factorial design, involving 85 primary-care practices (370 family practitioners) that request all laboratory tests from one regional centre. The interventions were quarterly feedback of practice requesting rates for nine laboratory tests, enhanced with educational messages, and brief educational reminder messages added to the test result reports for nine laboratory tests. The primary outcome was the number of targeted tests requested by primary-care practices during the 12 months of the intervention. This study is registered as an International Standard Randomised Controlled Trial, number ISRCTN06490422.
Findings
Practices that received either or both the enhanced feedback and the reminder messages were significantly less likely than the control group to request the targeted tests in total (enhanced feedback odds ratio 0·87, 95% CI 0·81—0·94; reminder messages 0·89, 0·83—0·93). The effect of the interventions varied across the targeted tests individually, although the number of tests requested for both interventions was generally reduced. Neither intervention was consistently better than the other.
Interpretation
Enhanced feedback of requesting rates and brief educational reminder messages, alone and in combination, are effective strategies for reducing test requesting in primary care. Both strategies are feasible within most laboratory settings.
Original languageEnglish
Pages (from-to)1990-1996
Number of pages6
JournalThe Lancet
Volume367
Issue number9527
DOIs
Publication statusPublished - Jun 2006

Fingerprint

Primary Health Care
Randomized Controlled Trials
Family Practice
Primary Care Physicians
Odds Ratio
Control Groups

Cite this

Effect of enhanced feedback and brief educational reminder messages on laboratory test requesting in primary care: a cluster randomised trial. / Thomas, Ruth Elizabeth; Croal, Bernard Lewis; Ramsay, Craig R; Eccles, M. P.; Grimshaw, J. M.

In: The Lancet, Vol. 367, No. 9527, 06.2006, p. 1990-1996.

Research output: Contribution to journalArticle

@article{70f0fe905bae4e699e6b30534c48ab42,
title = "Effect of enhanced feedback and brief educational reminder messages on laboratory test requesting in primary care: a cluster randomised trial",
abstract = "Background Laboratory services play an important part in screening, diagnosis, and management of patients within primary care. However, unnecessary use of laboratory tests is increasing. Our aim was to assess the effect of two interventions on the number of laboratory tests requested by primary-care physicians. Methods We did a cluster randomised controlled trial using a 2×2 factorial design, involving 85 primary-care practices (370 family practitioners) that request all laboratory tests from one regional centre. The interventions were quarterly feedback of practice requesting rates for nine laboratory tests, enhanced with educational messages, and brief educational reminder messages added to the test result reports for nine laboratory tests. The primary outcome was the number of targeted tests requested by primary-care practices during the 12 months of the intervention. This study is registered as an International Standard Randomised Controlled Trial, number ISRCTN06490422. Findings Practices that received either or both the enhanced feedback and the reminder messages were significantly less likely than the control group to request the targeted tests in total (enhanced feedback odds ratio 0·87, 95{\%} CI 0·81—0·94; reminder messages 0·89, 0·83—0·93). The effect of the interventions varied across the targeted tests individually, although the number of tests requested for both interventions was generally reduced. Neither intervention was consistently better than the other. Interpretation Enhanced feedback of requesting rates and brief educational reminder messages, alone and in combination, are effective strategies for reducing test requesting in primary care. Both strategies are feasible within most laboratory settings.",
author = "Thomas, {Ruth Elizabeth} and Croal, {Bernard Lewis} and Ramsay, {Craig R} and Eccles, {M. P.} and Grimshaw, {J. M.}",
year = "2006",
month = "6",
doi = "10.1016/S0140-6736(06)68888-0",
language = "English",
volume = "367",
pages = "1990--1996",
journal = "The Lancet",
issn = "0140-6736",
publisher = "ACADEMIC PRESS INC ELSEVIER SCIENCE",
number = "9527",

}

TY - JOUR

T1 - Effect of enhanced feedback and brief educational reminder messages on laboratory test requesting in primary care: a cluster randomised trial

AU - Thomas, Ruth Elizabeth

AU - Croal, Bernard Lewis

AU - Ramsay, Craig R

AU - Eccles, M. P.

AU - Grimshaw, J. M.

PY - 2006/6

Y1 - 2006/6

N2 - Background Laboratory services play an important part in screening, diagnosis, and management of patients within primary care. However, unnecessary use of laboratory tests is increasing. Our aim was to assess the effect of two interventions on the number of laboratory tests requested by primary-care physicians. Methods We did a cluster randomised controlled trial using a 2×2 factorial design, involving 85 primary-care practices (370 family practitioners) that request all laboratory tests from one regional centre. The interventions were quarterly feedback of practice requesting rates for nine laboratory tests, enhanced with educational messages, and brief educational reminder messages added to the test result reports for nine laboratory tests. The primary outcome was the number of targeted tests requested by primary-care practices during the 12 months of the intervention. This study is registered as an International Standard Randomised Controlled Trial, number ISRCTN06490422. Findings Practices that received either or both the enhanced feedback and the reminder messages were significantly less likely than the control group to request the targeted tests in total (enhanced feedback odds ratio 0·87, 95% CI 0·81—0·94; reminder messages 0·89, 0·83—0·93). The effect of the interventions varied across the targeted tests individually, although the number of tests requested for both interventions was generally reduced. Neither intervention was consistently better than the other. Interpretation Enhanced feedback of requesting rates and brief educational reminder messages, alone and in combination, are effective strategies for reducing test requesting in primary care. Both strategies are feasible within most laboratory settings.

AB - Background Laboratory services play an important part in screening, diagnosis, and management of patients within primary care. However, unnecessary use of laboratory tests is increasing. Our aim was to assess the effect of two interventions on the number of laboratory tests requested by primary-care physicians. Methods We did a cluster randomised controlled trial using a 2×2 factorial design, involving 85 primary-care practices (370 family practitioners) that request all laboratory tests from one regional centre. The interventions were quarterly feedback of practice requesting rates for nine laboratory tests, enhanced with educational messages, and brief educational reminder messages added to the test result reports for nine laboratory tests. The primary outcome was the number of targeted tests requested by primary-care practices during the 12 months of the intervention. This study is registered as an International Standard Randomised Controlled Trial, number ISRCTN06490422. Findings Practices that received either or both the enhanced feedback and the reminder messages were significantly less likely than the control group to request the targeted tests in total (enhanced feedback odds ratio 0·87, 95% CI 0·81—0·94; reminder messages 0·89, 0·83—0·93). The effect of the interventions varied across the targeted tests individually, although the number of tests requested for both interventions was generally reduced. Neither intervention was consistently better than the other. Interpretation Enhanced feedback of requesting rates and brief educational reminder messages, alone and in combination, are effective strategies for reducing test requesting in primary care. Both strategies are feasible within most laboratory settings.

U2 - 10.1016/S0140-6736(06)68888-0

DO - 10.1016/S0140-6736(06)68888-0

M3 - Article

VL - 367

SP - 1990

EP - 1996

JO - The Lancet

JF - The Lancet

SN - 0140-6736

IS - 9527

ER -