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Continuity of physician care does not reduce repeat lab tests


In contrast to previous assumptions, a new study from the Institute for Clinical Evaluative Sciences (ICES) has found that laboratory tests are more likely to be repeated when patients are seen by the same physician, rather than another different one.

“The pervasive belief, which is supported by several studies, is that poor continuity of care increases the chances that previously conducted tests will be repeated,” said Dr. Carl van Walraven, ICES adjunct scientist and lead author of the study.

“Often, patient-specific information can be poorly communicated between physicians who treat the same patient. This should increase the likelihood of test repetition if patients are seen by a second doctor.” However, this study found the opposite result. ICES Scientists tracked over 881,000 adults in eastern Ontario who had seven common laboratory tests conducted between September 1999 and September 2000. They compared the probability of test repetition if the initial test was ordered by the follow-up physician vs. another physician.

Among the over 1,419,000 initial laboratory tests and more than 7,622,000 follow-up physician visits, the odds that tests were repeated were 2.2 to 6.1 times higher when patients were seen in follow-up by the physician who had ordered the initial test.

“Our findings suggest that disseminating previous patient test results to all treating physicians may not decrease test repetition as much as would otherwise be expected,” said Dr. van Walraven.

“Physicians may repeat tests when they are abnormal, if the result does not match the patient’s symptoms, or to monitor patient conditions.

“Going forward, we need to determine if our results are consistent in other patient populations and for other investigations. In addition, we are presently studying the effect of information and provider continuity on patient outcomes after discharge from hospital.”

The study, “Effect of provider continuity on test repetition”, is in the December 2006 issue of the journal Clinical Chemistry.

Author affiliations: ICES (all authors); Clinical Epidemiology Program, Ottawa Heath Research Institute (Dr. van Walraven).

ICES is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy.     


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