title: Interventions at the laboratory level to reduce laboratory test ordering by family physicians: Systematic review.
abstract: OBJECTIVE
  To assess the effectiveness of interventions by laboratories and to increase rational and reduce unnecessary family physician test ordering.
  
  
  METHODS
  MEDLINE [1946-present], EMBASE [1980-present], EBM Reviews [1991-present](Cochrane Database of Systematic Reviews, ACP Journal Club, Database of Abstracts of Reviews of Effects, - Cochrane Central Register of Controlled Trials, Cochrane Methodology Register, Health Technology Assessment, NHS Economic Evaluation Database), PubMed [1966-present], PubMed Central [1900-present], Scopus [1960-present], Web of Science [1900-present] and CINAHL [1982-present] were searched with no language or publication limits. Non-randomised studies were assessed with the Newcastle-Ottawa scale.
  
  
  RESULTS
  The search identified 9282 titles and abstracts, 238 were read in full-text and 3 cohort and 7 before- and after-studies were included. Most focused on changing a few tests and evaluated the interventions over several months. Seven changed laboratory forms (the two largest involved 5.2 million and 3.2 million tests), one negotiated a test ordering protocol with family physicians, and two required laboratory approval. They achieved an average 35% reduction in the 19 targeted tests, with a wide range (0%-100% reduction).
  
  
  CONCLUSIONS
  Ten studies were identified which tested interventions by laboratories to reduce test ordering by family physicians, and achieved an average 35% reduction in the 19 targeted tests. The rationale for choosing specific tests for intervention was often not explained, most studies targeted a few tests for several months, the tests and test volumes differed widely across studies, no author improved the results of previous interventions or asked participants their opinions about the intervention or assessed factors impeding change.
authors.affiliation: Department of Family Medicine, Faculty of Medicine, University of Calgary, Calgary, Alberta T2N 4N1, Canada. Electronic address: rthomas@ucalgary.ca.
authors.forename: Roger E
authors.initials: RE
authors.lastname: Thomas
authors.affiliation: Knowledge Resource Service, Holy Cross Centre, Room 615A, 2210 2nd St. S.W., Calgary, Alberta T2S 3C3, Canada,. Electronic address: Marcus.Vaska@albertahealthservices.ca.
authors.forename: Marcus
authors.initials: M
authors.lastname: Vaska
authors.affiliation: Department of Pathology & Laboratory Medicine and Family Medicine, Faculty of Medicine, University of Calgary, Calgary, Alberta T2N 4N1, Canada; Department of Family Medicine, Faculty of Medicine, University of Calgary, Calgary, Alberta T2N 4N1, Canada. Electronic address: christopher.naugler@cls.ab.ca.
authors.forename: Christopher
authors.initials: C
authors.lastname: Naugler
authors.affiliation: Department of Family Medicine, Faculty of Medicine, University of Calgary, Calgary, Alberta T2N 4N1, Canada. Electronic address: turin.chowdhury@ucalgary.ca.
authors.forename: Tanvir C
authors.initials: TC
authors.lastname: Turin
mesh_terms: D003362:Cost-Benefit Analysis; D003955:Diagnostic Tests, Routine / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D007753:Laboratories / Q000191:economics* / Q000706:statistics & numerical data; D000069342:Medical Overuse / Q000191:economics / Q000517:prevention & control*; D010821:Physicians, Family / Q000941:ethics*; D010818:Practice Patterns, Physicians' / Q000941:ethics
keywords: Family physicians; Feedback; Laboratories; Utilisation