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1 Clinical Laboratory, General Hospital, Cockton Hill Road, Bishop Auckland, County Durham DL14 6AD, UK
2 Centre for Health and Medical Research, University of Teesside, UK
Dr Smellie Aims—To identify a model to assess general practitioner use of pathology services that could be applied to assess specific interventions designed to promote best practice.
Methods—A database containing standardised requesting data for 22 general practices was constructed. The database contained 28 tests covering 95% of general practitioner activity, distributed across pathology, and it was evaluated during two sequential six month periods. A comparison of ranks of requesting activity between different time periods was undertaken by calculating Pearson rank correlation coefficients. Requesting numbers were also adjusted for patients' age and sex distributions within the 22 practices for a sample of three high volume tests. The effects of distributing requesting guidelines and details of requesting activity were assessed during two sequential three month periods.
Results—Requesting activity was extremely stable during the two baseline periods for most tests (r > 0.80 for 20 of the 28 tests). Several less discriminatory tests were identified. Age and sex adjustment had minimal impact on the ranks of requesting activity. Requesting activity during the two three month periods after distributing guidelines and comparative details of individual requesting activity showed little change (overall correlation coefficient, 0.844 between baseline and intervention periods).
Conclusion—Ranking general practitioners requesting activity adjusted for practice list size provides a reproducible means of measuring requesting activity for most pathology tests performed in general practice. Activity was not influenced by age or sex of patients on the practice list. Distributing requesting guidelines and individual requesting activity on their own do not have any measurable impact on requesting activity. More innovative (possibly multiple) interventions might be required to influence general practitioner requesting practice.
Key Words: benchmarking • appropriateness • clinical governance
This article has been cited by other articles:
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  C. A. McNulty, M. Thomas, J. Bowen, C. Buckley, A. Charlett, D. Gelb, C. Foy, J. Sloss, and S. Smellie Improving the appropriateness of laboratory submissions for urinalysis from general practice Fam. Pract., August 1, 2008; 25(4): 272 - 278. [Abstract] [Full Text] [PDF]
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 W S A Smellie, D I Finnigan, D Wilson, D Freedman, C A M McNulty, and G Clark Methodology for constructing guidance J. Clin. Pathol., March 1, 2005; 58(3): 249 - 253. [Abstract] [Full Text] [PDF]
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W S A Smellie, G Clark, and C A M McNulty Inequalities of primary care microbiology testing between hospital catchment areas J. Clin. Pathol., December 1, 2003; 56(12): 933 - 936. [Abstract] [Full Text] [PDF]
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W S A Smellie, M J Galloway, D Chinn, and P Gedling Is clinical practice variability the major reason for differences in pathology requesting patterns in general practice? J. Clin. Pathol., April 1, 2002; 55(4): 312 - 314. [Abstract] [Full Text] [PDF]
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M Crook Clinical governance and pathology J. Clin. Pathol., March 1, 2002; 55(3): 177 - 179. [Abstract] [Full Text] [PDF]
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 W S. A Smellie, R. Lowrie, and E. Wilkinson Quality improvement report: A laboratory based intervention to improve appropriateness of lipid tests and audit cholesterol lowering in primary care BMJ, November 24, 2001; 323(7323): 1224 - 1227. [Abstract] [Full Text] [PDF]
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