title: Primary care physicians' challenges in ordering clinical laboratory tests and interpreting results.
abstract: BACKGROUND
  The number and complexity of clinical laboratory tests is rapidly expanding, presenting primary care physicians with challenges in accurately, efficiently, and safely ordering and interpreting diagnostic tests. The objective of this study was to identify challenges primary care physicians face related to diagnostic laboratory testing and solutions they believe are helpful and available to them.
  
  
  METHODS
  In this study, sponsored by the Centers for Disease Control and Prevention, a random sample of general internal medicine and family medicine physicians from the American Medical Association Masterfile were surveyed in 2011.
  
  
  RESULTS
  1768 physicians (5.6%) responded to the survey. Physicians reported ordering diagnostic laboratory tests for an average of 31.4% of patient encounters per week. They reported uncertainty about ordering tests in 14.7% and uncertainty in interpreting results in 8.3% of these diagnostic encounters. The most common problematic challenges in ordering tests were related to the cost to patients and insurance coverage restrictions. Other challenges included different names for the same test, tests not available except as part of a test panel, and different tests included in panels with the same names. The most common problematic challenges in interpreting and using test results were not receiving the results and confusing report formats. Respondents endorsed a variety of information technology and decision support solutions to improve test selection and results interpretation, but these solutions were not widely available at the time of the survey. Physicians infrequently sought assistance or consultation from laboratory professionals but valued these consultations when they occurred.
  
  
  CONCLUSIONS
  Primary care physicians routinely experience uncertainty and challenges in ordering and interpreting diagnostic laboratory tests. With more than 500 million primary care patient visits per year, the level of uncertainty reported in this study potentially affects 23 million patients per year and raises significant concerns about the safe and efficient use of laboratory testing resources. Improvement in information technology and clinical decision support systems and quick access to laboratory consultations may reduce physicians' uncertainty and mitigate these challenges.
authors.affiliation: the Department of Family Medicine, University of Illinois College of Medicine, Chicago; the Centers for Disease Control and Prevention, Atlanta, GA; the Altarum Institute, Ann Arbor, MI; Paul Epner LLC, Evanston, IL; and the Department of Pathology, University of Utah, Salt Lake City; and ARUP Laboratories, Salt Lake City, UT.
authors.forename: John
authors.initials: J
authors.lastname: Hickner
authors.forename: Pamela J
authors.initials: PJ
authors.lastname: Thompson
authors.forename: Tom
authors.initials: T
authors.lastname: Wilkinson
authors.forename: Paul
authors.initials: P
authors.lastname: Epner
authors.forename: Meghan
authors.initials: M
authors.lastname: Sheehan
authors.forename: Anne M
authors.initials: AM
authors.lastname: Pollock
authors.forename: Jim
authors.initials: J
authors.lastname: Lee
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Duke
authors.forename: Brian R
authors.initials: BR
authors.lastname: Jackson
authors.forename: Julie R
authors.initials: JR
authors.lastname: Taylor
mesh_terms: D001291:Attitude of Health Personnel; D064790:Clinical Laboratory Services / Q000191:economics / Q000706:statistics & numerical data; D019411:Clinical Laboratory Techniques / Q000191:economics / Q000379:methods / Q000706:statistics & numerical data; D020000:Decision Support Systems, Clinical; D005194:Family Practice / Q000191:economics / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D019458:Insurance Coverage; D007388:Internal Medicine / Q000191:economics / Q000379:methods / Q000706:statistics & numerical data; D008297:Male; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000191:economics / Q000379:methods* / Q000706:statistics & numerical data; D012017:Referral and Consultation; D035501:Uncertainty; D014481:United States
keywords: Diagnostic Services; Laboratories; Patient Safety; Primary Health Care