title: Big differences in primary care celiac disease serological markers request in Spain.
abstract: BACKGROUND
  Celiac disease (CD) prevalence is increasing but the disorder remains undiagnosed. The study compares CD serology markers requested by General Practitioners (GPs) over time and geographical areas. The aim of the current research is to assess the inter-practice and temporal variability in the request of CD serology markers by GPs in Spain, and the differences between regions.
  
  
  METHODS
  A cross-sectional study was conducted enrolling Spanish clinical laboratories. Primary care CD serology markers request in 2010, 2012 and 2014 from 15 autonomous communities (AACC), with more participants was reported. Test-utilization rates were calculated (tissue transglutaminase IgA antibodies (tTG-IgA) and deaminated peptide gliadine IgA antibodies (DGP-IgA) per 1000 inhabitants), and also the ratio of both tests request (DGP-IgA /tTG-IgA).
  
  
  RESULTS
  The request of tTG-IgA per 1000 inhabitants increased significantly along years (from 3.99 to 5.90 (P < 0.001)). The demand of DGP-IgAper1000 inhabitants was maintained in 2010 and 2012 (0.68 and 0.6), and decreased in 2014 (0.35) (P = 0.927). DGP-IgA /tTG-IgA diminished over time (from 0.16 to 0.06 (P = 0.548)), and in the 2014 edition, there was a significant regional difference, ranging from 0.01 to 0.57 (P < 0.001).
  
  
  CONCLUSIONS
  The variability in the request in CD serology markers emphasizes the need of inter-regional cooperation to develop strategies to optimize the use of laboratory tests.
authors.affiliation: Clinical Laboratory, Hospital Universitario de San Juan, San Juan de Alicante, Spain; Department of Biochemistry and Molecular Pathology, Universidad Miguel Hernandez, Elche, Spain.
authors.forename: Maria
authors.initials: M
authors.lastname: Salinas
authors.affiliation: Clinical Laboratory, Hospital Universitario de San Juan, San Juan de Alicante, Spain.
authors.forename: Maite
authors.initials: M
authors.lastname: López-Garrigós
authors.affiliation: Clinical Laboratory, Hospital Universitario de San Juan, San Juan de Alicante, Spain; Department of Clinical Medicine, Universidad Miguel Hernandez, Elche, Spain.
authors.forename: Emilio
authors.initials: E
authors.lastname: Flores
authors.affiliation: Department of Radiology, University of Virginia, Charlottesville, Virginia, USA.
authors.forename: Carlos
authors.initials: C
authors.lastname: Leiva-Salinas
mesh_terms: D015415:Biomarkers / Q000097:blood*; D002446:Celiac Disease / Q000097:blood* / Q000175:diagnosis*; D019963:Clinical Chemistry Tests / Q000592:standards*; D003430:Cross-Sectional Studies; D006801:Humans; D010818:Practice Patterns, Physicians' / Q000592:standards*; D011320:Primary Health Care / Q000592:standards*; D011786:Quality Control; D013030:Spain
chemical_list: D015415:Biomarkers
keywords: benchmarking; celiac disease; clinical laboratory services; quality indicators