Pathology test-ordering behaviour of Australian general practice trainees: a cross-sectional analysis.
OBJECTIVE
In the context of increasing over-testing and the implications for patient safety, to establish the prevalence and nature of pathology test-ordering of GP trainees, and to describe the associations of this test-ordering.


METHODS
A cross-sectional analysis of data from the Registrar Clinical Encounters in Training (ReCEnT) cohort study.


METHODS
Five of Australia's 17 general practice regional training providers, encompassing urban-to-very remote practices.


METHODS
GP trainees.


METHODS
The number of pathology tests ordered per problem/diagnosis managed.


RESULTS
A total of 856 individual trainees (response rate 95.2%) contributed data from 1832 trainee-terms, 108 759 encounters and 169 304 problems. Pathology test-ordering prevalence was 79.3 tests (95% CI: 78.8-79.8) per 100 encounters, 50.9 (95% CI: 50.6-51.3) per 100 problems, and at least 1 test was requested in 22.4% of consultations. Most commonly ordered was full blood count (6.1 per 100 problems). The commonest problem prompting test-ordering was 'check-up' (18.6%). Test-ordering was significantly associated, on multivariable analysis, with the trainee having worked at the practice previously; the patient being adult, male and new to both trainee and practice; the practice being urban; the problem/diagnosis being new; imaging being ordered; referral being made and follow-up being arranged. Trainees were significantly less likely to order tests for problems/diagnoses for which they had sought in-consultation information or advice.


CONCLUSIONS
Compared with the established GPs, trainees order more pathology tests per consultation and per problem managed, and in a higher proportion of consultations. Our findings will inform educational policy to enhance quality and safety in general practice training.
General Practice Training Valley to Coast, PO Box 573, HRMC, Mayfield, NSW 2310, Australia.
Simon
S
Morgan
General Practice Training Valley to Coast, PO Box 573, HRMC, Mayfield, NSW 2310, Australia.
Kim M
KM
Henderson
General Practice Training Valley to Coast, PO Box 573, HRMC, Mayfield, NSW 2310, Australia.
Amanda
A
Tapley
General Practice Training Valley to Coast, PO Box 573, HRMC, Mayfield, NSW 2310, Australia.
John
J
Scott
Discipline of General Practice, School of Medicine, The University of Queensland, L8 Health Sciences Building, Royal Brisbane and Women's Hospital, Brisbane ALD 4029, Australia.
Mieke L
ML
Van Driel
Victorian Metropolitan Alliance General Practice Training, 15 Cato Street, Hawthorn, VIC 3122, Australia.
Neil A
NA
Spike
Adelaide to Outback General Practice Training, Lower Level, 183 Melbourne Street, North Adelaide, SA 5006, Australia.
Lawrie A
LA
Mcarthur
Discipline of General Practice, University of Newcastle, Newbolds Building, University Drive, Callaghan, NSW 2308, Australia.
Andrew R
AR
Davey
Hunter Medical Research Unit, Locked Bag 1000, New Lambton, NSW 2305, Australia.
Chris
C
Oldmeadow
Hunter Medical Research Unit, Locked Bag 1000, New Lambton, NSW 2305, Australia.
Jean
J
Ball
General Practice Training Valley to Coast, PO Box 573, HRMC, Mayfield, NSW 2310, Australia Discipline of General Practice, University of Newcastle, Newbolds Building, University Drive, Callaghan, NSW 2308, Australia.
Parker J
PJ
Magin
D001315:Australia; D003430:Cross-Sectional Studies; D003955:Diagnostic Tests, Routine; D058006:General Practice; D058005:General Practitioners / Q000193:education*; D010818:Practice Patterns, Physicians'
appropriate health care; appropriateness; human resources; laboratory test; pathology; primary care/general practice; setting of care; training/education; under-use and over-use