Background: It is necessary to achieve a reduction in the number of requests for laboratory tests... more Background: It is necessary to achieve a reduction in the number of requests for laboratory tests by improving the appropriateness of testing behaviour. The aim of the study was, first, to compare laboratory requiring patterns for emergency department (ED) patients in clinical laboratories of different institutions in Spain; second, to design an appropriateness pre-pre-analytical quality control report based on appropriateness indicators. Methods: A call for data was posted on a website. We obtained production statistics for the year 2010 from emergency laboratories at 36 hospitals. Two types of appropriateness indicators were calculated: test request per 1000 ED admissions or related test requesting ratios. In order to explore the inter-practice variability in tests requests, the 'index of variability' was calculated. A pre-pre-analytical quality control report was designed, prepared and sent to each participating laboratory. The savings generated, if each Health-care Department would have achieved the appropriate indicator standard, were calculated. Results: The rate of request of the stat tests ranged from 44 to 412 per 1000 ED patient admissions. There was a high and peculiar dispersion of related test requesting ratio results. If every single laboratory would have achieved the appropriate indicator, we would have saved 1,019,230 urea, 302,511 AST and 316,161 CK unnecessary tests. Conclusions: There are large variations of test requesting in the emergency setting. An appropriateness pre-preanalytical quality control report was useful for comparing requesting patterns. The study shows the need to unify demand. The key to achieve this goal will be interdepartmental cooperation between ED clinicians and laboratory professionals.
Objective: We want to put on record two years' experience of undergraduate teaching of an optiona... more Objective: We want to put on record two years' experience of undergraduate teaching of an optional subject, "Medicine at the Primary Care level". This was given to sixth-year students by Family and Community Medicine specialist doctors within the Department of Medicine. Design and setting: A crossover study carried out at the University of Alicante. Participants: In the first year, 73 out of the 102 students making up the complete course took part (71.6%); and in the second year, 33 out of 93 (35.5%). Measurements and main results: The methodology employed, the teaching staff and the documents handed out were given high marks by the students in both cases; as were the course contents in the second year. Deficiencies were noted in the presentation of practical hypotheses. In the first course the students criticised the lack of certain points, basically the tackling of the more common chronic pathologies, something which was corrected in the second year. The survey identified students' wishes to spend longer on the subject. Conclusions: The students valued positively the existence of a theoretical content specific to Primary Care Medicine. In particular, they requested to be taught performance patterns for prevalent pathologies and for seminars to be organised around practical hypotheses.
a,d , Joaquín Uris e , Carlos Leiva-Salinas f , on behalf of the rest of authors of Grupo piloto ... more a,d , Joaquín Uris e , Carlos Leiva-Salinas f , on behalf of the rest of authors of Grupo piloto para la adecuación de la demanda de pruebas de laboratorio (REDCONLAB) ♦
The study was performed to compare the variability and appropriateness in the request of glycated... more The study was performed to compare the variability and appropriateness in the request of glycated hemoglobin (HbA1c) in primary care in Spain. Design and methods: 76 Spanish laboratories from diverse regions across Spain filled out the number of HbA1c tests requested by general practitioners (GPs) during the year 2012. Every patient seen at the different primary care centers was included in the study. Each participating laboratory was required to provide organizational data. The number of HbA1c requests per 1000 inhabitants was calculated and compared between regions. To investigate whether HbA1c was appropriately requested to manage and to diagnose Diabetes Mellitus (DM), the number of necessary HbA1c was calculated, according to the disease prevalence in Spain (6.9%) and the guidelines regarding DM management and diagnosis. Results: 17679195 patients were included in the study. A total of 1544551 HbA1c tests were ordered. No significant difference in the number of HbA1c requests per 1000 inhabitants was seen according to hospital setting (rural, urban or rural-urban). No significant differences were noticed between 3 Spanish regions, except the Valencian Community that presented higher values. Regarding the request appropriateness, 3280183 additional tests would have been necessary to manage diabetic patients and to diagnose new patients with the disease. Conclusion: There was a high variability regarding the request of HbA1c; the test was under-requested in all the participating health departments. This emphasizes the need to accomplish interventions to improve an appropriate use.
Objectives: The aim was to study the inter-practice variability in anemia laboratory tests reques... more Objectives: The aim was to study the inter-practice variability in anemia laboratory tests requested by general practitioners in Spain, to evaluate for a potential requesting inappropriateness. Methods: Laboratories from diverse Spanish regions filled out the number of cell blood count, ferritin, folate, iron, transferrin, and vitamin B12 requested by general practitioners during 2012. The number of test requests per 1000 inhabitants and ratios of related tests requests were calculated. The results obtained in hospitals from different areas (urban, rural, or urban-rural), type of management (public or private), and geographic regions were compared. Results: There was a high variability in the number of test requests and ratios of related tests. Cell blood count was over requested in rural areas and in hospitals with private management. Andalucía was the community with the lowest number of iron requests and the lowest folate/vitamin B12 indicator value. Conclusions: Iron and transferrin seemed over requested in some areas; as were folate and ferritin when compared to vitamin B12 and cell blood count, respectively. The differences observed between areas indicate that other factors besides clinical reasons could be behind that variability and emphasize the need to accomplish interventions to improve the appropriate use of anemia laboratory tests.
Error de laboratorio; Variabilidad preanalítica; Seguridad del paciente Resumen Objetivo: Mostrar... more Error de laboratorio; Variabilidad preanalítica; Seguridad del paciente Resumen Objetivo: Mostrar el número y tipo de incidencias preanalíticas en los centros de extracción perif erica (CEP) del Departamento de Salud 17 de la Agencia Valenciana de Salud. M etodo: El estudio se ha llevado a cabo durante 35 meses (mayo 2005-marzo 2008) sobre las 362.054 solicitudes y las 2.880.742 pruebas que se han recibido de los 16 CEP de Atención Primaria del Departamento de Salud 17. Las incidencias son registradas en el sistema de información de laboratorio mediante un resultado codificado específico en la prueba solicitada. La procedencia de la muestra afectada se conoce mediante el número de petición que es específico para cada CEP. Los resultados codificados y las muestras afectadas son recogidos autom aticamente mediante un software basado en cubos On-Line Analytical Processing (OLAP) (Omnium s , Roche Diagnostics s). Calculamos las incidencias (expresadas en defectos por millón de oportunidades) para cada tipo de muestra en cada uno de los CEP. Se clasificaron los errores preanalíticos en dos grandes grupos: errores debidos a la pericia extractora (muestra coagulada, insuficiente o hemolizada) y error debido a fallo de proceso (muestra no disponible). El tratamiento de los datos obtenidos se ha realizado mediante Microsoft Excel 2003. Las variables son expresadas como frecuencia y porcentaje. Resultados: El mayor número de incidencias tuvo lugar en las muestras de orina (5.358 [52%]), seguidas por las de coagulación (2.164 [21%]), hematología (1.752 [17%]) y bioquímica (1.030 [10%]). Con respecto al tipo de error, la mayor proporción de errores fue debida a fallos de proceso (7.007 [62%]).
Estudio de la relación entre las concentraciones plasmáticas de adiponectina, interleucina 18 y g... more Estudio de la relación entre las concentraciones plasmáticas de adiponectina, interleucina 18 y ghrelina y la densidad mineral ósea en mujeres con obesidad mórbida tras bypass gástrico Factores relacionados con la persistencia de la enfermedad a los 5 años del diagnóstico de cáncer diferenciado de tiroides: estudio de 63 pacientes ▶ Revisión Mutaciones de AIP en adenomas hipofisarios familiares y esporádicos: experiencia local y revisión de la literatura ▶ Notas clínicas Un efecto secundario grave: sepsis por carbimazol Remisión del hipercortisolismo tras suprarrenalectomía unilateral en paciente con enfermedad de Cushing persistente e hiperplasia adrenal macronodular Bocio amiloide secundario a enfermedad de Crohn ▶ Cartas al Director Miopatía proximal secundaria a tratamiento con estatinas en paciente con tiroiditis de Hashimoto
Introduction: To compare the inter-practice variability in lipid metabolism laboratory tests requ... more Introduction: To compare the inter-practice variability in lipid metabolism laboratory tests requested by General Practitioners in Spain using appropriateness indicators and investigate the variability according to the different characteristics of the geographical regions. Materials and methods: 141 clinical laboratories were invited to participate from diverse regions across Spain. We obtained the number of serum cholesterol, high-density cholesterol (HDL-cholesterol) and triglycerides requested by General Practitioners for the year 2012. Two types of appropriateness indicators were calculated: test requests per 1000 inhabitants and ratio of related tests requests (HDL-cholesterol/cholesterol, triglycerides /cholesterol). The indicators results obtained in different setting, with different type of management and in different geographical areas were compared. Results: We obtained production statistics from 76 laboratories who attended a population of 17,679,195 inhabitants from 13 Communities throughout Spain. 5,823,053 cholesterol, 4,544,663 HDL-cholesterol and 5,599,358 triglycerides tests were ordered. Cholesterol, HDLcholesterol and triglycerides per 1000 inhabitants indicators results ranged from 106.3 to 550.7; 20.4 to 417.5 and from 94.0 to 439.2 respectively. HDL-cholesterol/cholesterol, triglycerides/cholesterol indicators results ranged from 0.19 to 1.00 and from 0.54 to 1.00 respectively. Cholesterol, HDL-cholesterol and triglycerides were higher requested in rural areas. No significant differences in tests requests were observed based on Spanish Community.
Objective: To assess the opinion of medical students on the teaching offered in the Primary Care ... more Objective: To assess the opinion of medical students on the teaching offered in the Primary Care context (TOPC). Design: Observational and crossover study. The assessment used an opinion questionnaire. Participants: 296 sixth-year medical students between 1987 and 1992. Interventions: The TOPC consisted of four weeks stay in a Health Centre with an eminently practical programme. However this also included hour-long theoretical seminars on the most important Primary Care questions and the student's completion of a research project related to Primary Care. Results: The students expressed satisfaction with the TOPC (average score of 4 out of 5). Moreover this satisfaction increased over the five years (from 3.7 to 4.6, p = 0.0001). They believed the TOPC to be useful (3.6 to 4.7, p = 0.0001) and relevant to their future professional activity (3.1 to 4.6, p = 0.0001). They thought that the tutors were very competent (4 out of 5, with no significant variation) and the Health Centres' teaching facilities suitable (3.8 to 4, with no significant variation). Finally, they considered that TOPC should become a compulsory undergraduate subject (3.9 out of 5). Conclusions: Medical students give a positive rating to the Primary Care teaching offered and believe it should be integrated into the Medicine syllabus as a compulsory subject.
Background: Knowledge about the variability in the request of calcium-phosphate metabolism labora... more Background: Knowledge about the variability in the request of calcium-phosphate metabolism laboratory tests in primary care is important to design strategies to improve health system efficiency. Aim: To compare the inter-practice variability in calcium-phosphate metabolism laboratory tests requested by general practitioners from diverse regions across Spain. Material and Methods: One hundred and forty one clinical laboratories were invited to participate in an observational cross-sectional study. They informed the number of serum calcium, phosphate, parathyroid hormone and 25-hydroxyvitamin D requested by general practitioners. Appropriateness indicators were calculated as number of test requests per 1,000 inhabitants and ratio of related tests requests. The differences according to hospital setting, region and type of management were analyzed. Results: We recruited 76 laboratories (17,679,195 inhabitants). General practitioners requested 3,260,894 calcium-phosphate metabolism tests. The rate of request ranged from 2.97 per 1,000 inhabitants for 25-hydroxyvitamin D to 98.89 per 1,000 inhabitants for calcium. The rates of request for calcium, phosphate, parathyroid hormone in some areas were 30, 100 and 340 times higher than in other areas. Parathyroid hormone and 25-hydroxyvitamin D were highly requested in private management areas. There were also differences in phosphate, parathyroid hormone and 25-hydroxyvitamin D requesting between regions across Spain. Conclusions: The high variability observed is difficult to explain by differences in patient case mix between regions. Depending on the area, calcium could be under requested to detect primary hyperparathyroidism.
Objetivo: Comparar los patrones de solicitud de pruebas de laboratorio en pacientes que acuden al... more Objetivo: Comparar los patrones de solicitud de pruebas de laboratorio en pacientes que acuden al servicio de urgencias (SU) en Espana. Metodos: Estudiamos el numero de solicitudes de 20 pruebas de laboratorio en pacientes que acudieron al SU de 76 hospitales espanoles, durante el ano 2012. Calculamos el numero de solicitudes de cada prueba por cada 1000 pacientes atendidos y ciertos ratios de pruebas relacionadas. Comparamos dichos valores con valores objetivos a alcanzar. Comparamos la demanda entre hospitales de acuerdo a su tipo de gestion, localizacion y tamano. Resultados: La variabilidad en la utilizacion de pruebas urgentes fue muy significativa, siendo mayor en las pruebas menos solicitadas. En doce hospitales solo se procesaba una transaminasa, en nueve solo alanina amino-transferasa y en tres aspartato amino-transferasa unicamente. Ademas de amilasa, la mitad de los hospitales procesaban lipasa. En la mayoria de los centros se solicito mas numero de creatinquinasa que troponina. La urea y creatinina eran pedidas de forma redundante en la mayoria de servicios. En un tercio de hospitales no se procesaba albumina ni peptido natriuretico de tipo B y en un cuarto tampoco la procalcitonina. Se observaron diferencias entre hospitales de distintas comunidades, zonas geograficas, tipo de gestion o tamano. Conclusion: Existe una altisima variabilidad en el numero de pruebas solicitadas al laboratorio desde los SU y en las disponibles a solicitar. Sera necesario decidir cuales son las idoneas mediante la comunicacion entre los profesionales del SU y laboratorio para la mayor contribucion del laboratorio en el manejo del paciente urgente.
To study the inter-practice variability in Spain-by institution, management, and regional charact... more To study the inter-practice variability in Spain-by institution, management, and regional characteristics-of the frequency and appropriateness of test requests made by primary care practitioners for acute phase markers. Observational cross-sectional study. One hundred forty-one clinical laboratories were invited to participate by providing the number of erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and complete blood count (CBC) tests requested by general practitioners. We calculated the ratio of test requests per 1000 inhabitants, ratios of related test requests, and variability index (90th percentile/10th percentile). We compared the results among the different areas according to their setting, location, and management. We recruited 64 laboratories (14,846,065 inhabitants). There were almost twice as many ESR requests as CRP requests; the variability index for ESR was almost double that of CRP. Furthermore, the latter was underrequested in rural-urban areas compa...
Background: It is necessary to achieve a reduction in the number of requests for laboratory tests... more Background: It is necessary to achieve a reduction in the number of requests for laboratory tests by improving the appropriateness of testing behaviour. The aim of the study was, first, to compare laboratory requiring patterns for emergency department (ED) patients in clinical laboratories of different institutions in Spain; second, to design an appropriateness pre-pre-analytical quality control report based on appropriateness indicators. Methods: A call for data was posted on a website. We obtained production statistics for the year 2010 from emergency laboratories at 36 hospitals. Two types of appropriateness indicators were calculated: test request per 1000 ED admissions or related test requesting ratios. In order to explore the inter-practice variability in tests requests, the 'index of variability' was calculated. A pre-pre-analytical quality control report was designed, prepared and sent to each participating laboratory. The savings generated, if each Health-care Department would have achieved the appropriate indicator standard, were calculated. Results: The rate of request of the stat tests ranged from 44 to 412 per 1000 ED patient admissions. There was a high and peculiar dispersion of related test requesting ratio results. If every single laboratory would have achieved the appropriate indicator, we would have saved 1,019,230 urea, 302,511 AST and 316,161 CK unnecessary tests. Conclusions: There are large variations of test requesting in the emergency setting. An appropriateness pre-preanalytical quality control report was useful for comparing requesting patterns. The study shows the need to unify demand. The key to achieve this goal will be interdepartmental cooperation between ED clinicians and laboratory professionals.
Objective: We want to put on record two years' experience of undergraduate teaching of an optiona... more Objective: We want to put on record two years' experience of undergraduate teaching of an optional subject, "Medicine at the Primary Care level". This was given to sixth-year students by Family and Community Medicine specialist doctors within the Department of Medicine. Design and setting: A crossover study carried out at the University of Alicante. Participants: In the first year, 73 out of the 102 students making up the complete course took part (71.6%); and in the second year, 33 out of 93 (35.5%). Measurements and main results: The methodology employed, the teaching staff and the documents handed out were given high marks by the students in both cases; as were the course contents in the second year. Deficiencies were noted in the presentation of practical hypotheses. In the first course the students criticised the lack of certain points, basically the tackling of the more common chronic pathologies, something which was corrected in the second year. The survey identified students' wishes to spend longer on the subject. Conclusions: The students valued positively the existence of a theoretical content specific to Primary Care Medicine. In particular, they requested to be taught performance patterns for prevalent pathologies and for seminars to be organised around practical hypotheses.
a,d , Joaquín Uris e , Carlos Leiva-Salinas f , on behalf of the rest of authors of Grupo piloto ... more a,d , Joaquín Uris e , Carlos Leiva-Salinas f , on behalf of the rest of authors of Grupo piloto para la adecuación de la demanda de pruebas de laboratorio (REDCONLAB) ♦
The study was performed to compare the variability and appropriateness in the request of glycated... more The study was performed to compare the variability and appropriateness in the request of glycated hemoglobin (HbA1c) in primary care in Spain. Design and methods: 76 Spanish laboratories from diverse regions across Spain filled out the number of HbA1c tests requested by general practitioners (GPs) during the year 2012. Every patient seen at the different primary care centers was included in the study. Each participating laboratory was required to provide organizational data. The number of HbA1c requests per 1000 inhabitants was calculated and compared between regions. To investigate whether HbA1c was appropriately requested to manage and to diagnose Diabetes Mellitus (DM), the number of necessary HbA1c was calculated, according to the disease prevalence in Spain (6.9%) and the guidelines regarding DM management and diagnosis. Results: 17679195 patients were included in the study. A total of 1544551 HbA1c tests were ordered. No significant difference in the number of HbA1c requests per 1000 inhabitants was seen according to hospital setting (rural, urban or rural-urban). No significant differences were noticed between 3 Spanish regions, except the Valencian Community that presented higher values. Regarding the request appropriateness, 3280183 additional tests would have been necessary to manage diabetic patients and to diagnose new patients with the disease. Conclusion: There was a high variability regarding the request of HbA1c; the test was under-requested in all the participating health departments. This emphasizes the need to accomplish interventions to improve an appropriate use.
Objectives: The aim was to study the inter-practice variability in anemia laboratory tests reques... more Objectives: The aim was to study the inter-practice variability in anemia laboratory tests requested by general practitioners in Spain, to evaluate for a potential requesting inappropriateness. Methods: Laboratories from diverse Spanish regions filled out the number of cell blood count, ferritin, folate, iron, transferrin, and vitamin B12 requested by general practitioners during 2012. The number of test requests per 1000 inhabitants and ratios of related tests requests were calculated. The results obtained in hospitals from different areas (urban, rural, or urban-rural), type of management (public or private), and geographic regions were compared. Results: There was a high variability in the number of test requests and ratios of related tests. Cell blood count was over requested in rural areas and in hospitals with private management. Andalucía was the community with the lowest number of iron requests and the lowest folate/vitamin B12 indicator value. Conclusions: Iron and transferrin seemed over requested in some areas; as were folate and ferritin when compared to vitamin B12 and cell blood count, respectively. The differences observed between areas indicate that other factors besides clinical reasons could be behind that variability and emphasize the need to accomplish interventions to improve the appropriate use of anemia laboratory tests.
Error de laboratorio; Variabilidad preanalítica; Seguridad del paciente Resumen Objetivo: Mostrar... more Error de laboratorio; Variabilidad preanalítica; Seguridad del paciente Resumen Objetivo: Mostrar el número y tipo de incidencias preanalíticas en los centros de extracción perif erica (CEP) del Departamento de Salud 17 de la Agencia Valenciana de Salud. M etodo: El estudio se ha llevado a cabo durante 35 meses (mayo 2005-marzo 2008) sobre las 362.054 solicitudes y las 2.880.742 pruebas que se han recibido de los 16 CEP de Atención Primaria del Departamento de Salud 17. Las incidencias son registradas en el sistema de información de laboratorio mediante un resultado codificado específico en la prueba solicitada. La procedencia de la muestra afectada se conoce mediante el número de petición que es específico para cada CEP. Los resultados codificados y las muestras afectadas son recogidos autom aticamente mediante un software basado en cubos On-Line Analytical Processing (OLAP) (Omnium s , Roche Diagnostics s). Calculamos las incidencias (expresadas en defectos por millón de oportunidades) para cada tipo de muestra en cada uno de los CEP. Se clasificaron los errores preanalíticos en dos grandes grupos: errores debidos a la pericia extractora (muestra coagulada, insuficiente o hemolizada) y error debido a fallo de proceso (muestra no disponible). El tratamiento de los datos obtenidos se ha realizado mediante Microsoft Excel 2003. Las variables son expresadas como frecuencia y porcentaje. Resultados: El mayor número de incidencias tuvo lugar en las muestras de orina (5.358 [52%]), seguidas por las de coagulación (2.164 [21%]), hematología (1.752 [17%]) y bioquímica (1.030 [10%]). Con respecto al tipo de error, la mayor proporción de errores fue debida a fallos de proceso (7.007 [62%]).
Estudio de la relación entre las concentraciones plasmáticas de adiponectina, interleucina 18 y g... more Estudio de la relación entre las concentraciones plasmáticas de adiponectina, interleucina 18 y ghrelina y la densidad mineral ósea en mujeres con obesidad mórbida tras bypass gástrico Factores relacionados con la persistencia de la enfermedad a los 5 años del diagnóstico de cáncer diferenciado de tiroides: estudio de 63 pacientes ▶ Revisión Mutaciones de AIP en adenomas hipofisarios familiares y esporádicos: experiencia local y revisión de la literatura ▶ Notas clínicas Un efecto secundario grave: sepsis por carbimazol Remisión del hipercortisolismo tras suprarrenalectomía unilateral en paciente con enfermedad de Cushing persistente e hiperplasia adrenal macronodular Bocio amiloide secundario a enfermedad de Crohn ▶ Cartas al Director Miopatía proximal secundaria a tratamiento con estatinas en paciente con tiroiditis de Hashimoto
Introduction: To compare the inter-practice variability in lipid metabolism laboratory tests requ... more Introduction: To compare the inter-practice variability in lipid metabolism laboratory tests requested by General Practitioners in Spain using appropriateness indicators and investigate the variability according to the different characteristics of the geographical regions. Materials and methods: 141 clinical laboratories were invited to participate from diverse regions across Spain. We obtained the number of serum cholesterol, high-density cholesterol (HDL-cholesterol) and triglycerides requested by General Practitioners for the year 2012. Two types of appropriateness indicators were calculated: test requests per 1000 inhabitants and ratio of related tests requests (HDL-cholesterol/cholesterol, triglycerides /cholesterol). The indicators results obtained in different setting, with different type of management and in different geographical areas were compared. Results: We obtained production statistics from 76 laboratories who attended a population of 17,679,195 inhabitants from 13 Communities throughout Spain. 5,823,053 cholesterol, 4,544,663 HDL-cholesterol and 5,599,358 triglycerides tests were ordered. Cholesterol, HDLcholesterol and triglycerides per 1000 inhabitants indicators results ranged from 106.3 to 550.7; 20.4 to 417.5 and from 94.0 to 439.2 respectively. HDL-cholesterol/cholesterol, triglycerides/cholesterol indicators results ranged from 0.19 to 1.00 and from 0.54 to 1.00 respectively. Cholesterol, HDL-cholesterol and triglycerides were higher requested in rural areas. No significant differences in tests requests were observed based on Spanish Community.
Objective: To assess the opinion of medical students on the teaching offered in the Primary Care ... more Objective: To assess the opinion of medical students on the teaching offered in the Primary Care context (TOPC). Design: Observational and crossover study. The assessment used an opinion questionnaire. Participants: 296 sixth-year medical students between 1987 and 1992. Interventions: The TOPC consisted of four weeks stay in a Health Centre with an eminently practical programme. However this also included hour-long theoretical seminars on the most important Primary Care questions and the student's completion of a research project related to Primary Care. Results: The students expressed satisfaction with the TOPC (average score of 4 out of 5). Moreover this satisfaction increased over the five years (from 3.7 to 4.6, p = 0.0001). They believed the TOPC to be useful (3.6 to 4.7, p = 0.0001) and relevant to their future professional activity (3.1 to 4.6, p = 0.0001). They thought that the tutors were very competent (4 out of 5, with no significant variation) and the Health Centres' teaching facilities suitable (3.8 to 4, with no significant variation). Finally, they considered that TOPC should become a compulsory undergraduate subject (3.9 out of 5). Conclusions: Medical students give a positive rating to the Primary Care teaching offered and believe it should be integrated into the Medicine syllabus as a compulsory subject.
Background: Knowledge about the variability in the request of calcium-phosphate metabolism labora... more Background: Knowledge about the variability in the request of calcium-phosphate metabolism laboratory tests in primary care is important to design strategies to improve health system efficiency. Aim: To compare the inter-practice variability in calcium-phosphate metabolism laboratory tests requested by general practitioners from diverse regions across Spain. Material and Methods: One hundred and forty one clinical laboratories were invited to participate in an observational cross-sectional study. They informed the number of serum calcium, phosphate, parathyroid hormone and 25-hydroxyvitamin D requested by general practitioners. Appropriateness indicators were calculated as number of test requests per 1,000 inhabitants and ratio of related tests requests. The differences according to hospital setting, region and type of management were analyzed. Results: We recruited 76 laboratories (17,679,195 inhabitants). General practitioners requested 3,260,894 calcium-phosphate metabolism tests. The rate of request ranged from 2.97 per 1,000 inhabitants for 25-hydroxyvitamin D to 98.89 per 1,000 inhabitants for calcium. The rates of request for calcium, phosphate, parathyroid hormone in some areas were 30, 100 and 340 times higher than in other areas. Parathyroid hormone and 25-hydroxyvitamin D were highly requested in private management areas. There were also differences in phosphate, parathyroid hormone and 25-hydroxyvitamin D requesting between regions across Spain. Conclusions: The high variability observed is difficult to explain by differences in patient case mix between regions. Depending on the area, calcium could be under requested to detect primary hyperparathyroidism.
Objetivo: Comparar los patrones de solicitud de pruebas de laboratorio en pacientes que acuden al... more Objetivo: Comparar los patrones de solicitud de pruebas de laboratorio en pacientes que acuden al servicio de urgencias (SU) en Espana. Metodos: Estudiamos el numero de solicitudes de 20 pruebas de laboratorio en pacientes que acudieron al SU de 76 hospitales espanoles, durante el ano 2012. Calculamos el numero de solicitudes de cada prueba por cada 1000 pacientes atendidos y ciertos ratios de pruebas relacionadas. Comparamos dichos valores con valores objetivos a alcanzar. Comparamos la demanda entre hospitales de acuerdo a su tipo de gestion, localizacion y tamano. Resultados: La variabilidad en la utilizacion de pruebas urgentes fue muy significativa, siendo mayor en las pruebas menos solicitadas. En doce hospitales solo se procesaba una transaminasa, en nueve solo alanina amino-transferasa y en tres aspartato amino-transferasa unicamente. Ademas de amilasa, la mitad de los hospitales procesaban lipasa. En la mayoria de los centros se solicito mas numero de creatinquinasa que troponina. La urea y creatinina eran pedidas de forma redundante en la mayoria de servicios. En un tercio de hospitales no se procesaba albumina ni peptido natriuretico de tipo B y en un cuarto tampoco la procalcitonina. Se observaron diferencias entre hospitales de distintas comunidades, zonas geograficas, tipo de gestion o tamano. Conclusion: Existe una altisima variabilidad en el numero de pruebas solicitadas al laboratorio desde los SU y en las disponibles a solicitar. Sera necesario decidir cuales son las idoneas mediante la comunicacion entre los profesionales del SU y laboratorio para la mayor contribucion del laboratorio en el manejo del paciente urgente.
To study the inter-practice variability in Spain-by institution, management, and regional charact... more To study the inter-practice variability in Spain-by institution, management, and regional characteristics-of the frequency and appropriateness of test requests made by primary care practitioners for acute phase markers. Observational cross-sectional study. One hundred forty-one clinical laboratories were invited to participate by providing the number of erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and complete blood count (CBC) tests requested by general practitioners. We calculated the ratio of test requests per 1000 inhabitants, ratios of related test requests, and variability index (90th percentile/10th percentile). We compared the results among the different areas according to their setting, location, and management. We recruited 64 laboratories (14,846,065 inhabitants). There were almost twice as many ESR requests as CRP requests; the variability index for ESR was almost double that of CRP. Furthermore, the latter was underrequested in rural-urban areas compa...
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