GP pathology ordering up 20% in three years

There was a 20% increase in the number of pathology tests ordered by GPs between 1998-99 and 2000-01, according to a new report released today by the Australian Institute of Health and Welfare and the University of Sydney.

There was no change in the likelihood of a GP ordering pathology at any given consultation, but when they did order pathology they ordered more tests.

The report, Changes in Pathology Ordering by GPs in Australia 1998 to 2001, found that the number of tests (or groups of tests) ordered rose from 25 to 29 tests per 100 consultations over the three years.

This represents a rise in the annual number of GP-ordered pathology tests from approximately 180 million to 210 million.

Director of the AIHW General Practice Statistics and Classification Unit at the University of Sydney, Professor Helena Britt, said that the rises were indicative of an overall move from ordering a single test for a problem to multiple test orders.

'When GPs ordered pathology, they ordered an average of 2.1 tests per problem in 2000-01 compared with 1.8 tests per problem in 1998-99', Professor Britt said.

The biggest increases in kinds of tests ordered by GPs were: full blood counts; lipid tests; glucose, electrolyte, urea and creatinine tests (EUCs); multibiochemical analysis; and hormone assays.

The health problems accounting for the most significant increases in ordered pathology tests were management of heart disease, diabetes and blood pressure. More tests were also being ordered for patients with weakness/tiredness, high cholesterol, and thyroid problems.

The study showed that some GPs order more pathology tests than others, particularly female GPs, younger GPs, GPs in larger practices and those working in rural areas.

'The increase in pathology test orders cannot be explained, however, by changes in the characteristics of the GPs-such changes were marginal over the period', Professor Britt said.

And the increase could not be explained by changes in the types of patients or the pattern of problems managed either.

'We must look elsewhere for the reasons. The increase may reflect improved levels of preventive care, and increased use of protocols and guidelines for the care of patients with specific problems, such as diabetes and heart disease.'

'It may also reflect other influences such as increased use of computers by GPs, or increased fear of litigation by GPs.'

'We really don't know whether increased ordering is a good or a bad thing in terms of quality of the care provided,' Professor Britt said.

Information for the study was drawn from over 3000 GPs across the country, covering 300,000 GP-patient consultations, as part of the BEACH (Bettering the Evaluation and Care of Health) program, a continuous national study of general practice activity.

19 November 2003

Further information: A/Prof Helena Britt, tel. (02) 9845 8150 or 0411 197 938
Media copies of the report: Publications Officer, AIHW tel. (02) 6244 1032, OR Media Office, University of Sydney, 02 9351 2261