title: A qualitative exploration of the motives behind the decision to order a liver function test in primary care.
abstract: BACKGROUND
  The number of tests ordered in primary care continues to increase influenced by a number of factors not all of which are concerned with diagnosis and management of disease. Liver function tests (LFTs) are a good example of inexpensive tests that are frequently ordered in patients with non-specific symptoms. They remain among the most frequently ordered tests despite their lack of specificity yet the full range of motives behind the decision to order an LFT remains unexplored.
  
  
  OBJECTIVE
  To gain an understanding of the family practitioner's (FP) medical and non-medical motives for ordering an LFT and the influence of various social and technical factors on this decision.
  
  
  METHODS
  We interviewed FPs across six practices who were participating in a prospective study of the efficacy of an abnormal LFT to indicate the development of a serious liver disease. Following content analysis of the data from the semi-structured interviews we used the 'attitude-social influence-efficacy' model to categorise the determinants of test ordering behaviour.
  
  
  RESULTS
  Factors influencing an FP's decision to order a test were grouped into two broad categories; the first is 'internal' including expectation of efficacy and general attitude towards LFTs. The second group is 'external' and consists of themes of social influence, tests characteristics and defensive medicine.
  
  
  CONCLUSIONS
  Whilst our sample acknowledged the clinical use of LFTs such as the routine monitoring of medication and liver-specific diagnostic purposes we also found that social and behavioural reasons are strong motivators to order an LFT and may take precedence over clinical factors.
authors.affiliation: Institute of Occupational and Environmental Medicine, University of Birmingham, Edgbaston B15 2TT, UK.; litchfii@adf.bham.ac.uk.
authors.forename: I J
authors.initials: IJ
authors.lastname: Litchfield
authors.affiliation: Warwick Centre for Applied Health Research and Delivery, Health Sciences, University of Warwick, Warwick Medical School, Coventry, UK.
authors.forename: R J
authors.initials: RJ
authors.lastname: Lilford
authors.affiliation: Health and Population Sciences, University of Birmingham, UK.
authors.forename: L M
authors.initials: LM
authors.lastname: Bentham
authors.affiliation: Health and Population Sciences, University of Birmingham, UK.
authors.forename: S M
authors.initials: SM
authors.lastname: Greenfield
mesh_terms: D000328:Adult; D005260:Female; D058005:General Practitioners / Q000523:psychology*; D006801:Humans; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D009042:Motivation; D010808:Physical Examination; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care; D011446:Prospective Studies