More clarity is needed on how often certain laboratory testing should be done for long-term conditions in general practice, say researchers who found large variation in their use.
Analysis of UK GP records of almost a million patients with hypertension, type 2 diabetes and chronic kidney disease (CKD) found some practices had 27 times higher testing rates than others for certain tests.
The data from 2013 to 2018, also showed some evidence of both undertesting and overtesting for specific tests compared with current guidelines.
Overall, the team at the University of Bristol found that while testing rates are no longer increasing, they are not always within the guidelines and there is considerable variation in the approach of different practices.
‘Standardising the monitoring of long-term conditions based on the latest evidence would provide greater consistency of access to monitoring tests,’ they concluded in BJGP Open.
The analysis showed that the most common tests for hypertension, type 2 diabetes, and CKD were renal function, liver function, full blood count, lipid profile, and HbA1c.
Evidence of undertesting of patients was seen with HbA1c and albumin:creatinine ratio or microalbumin, the researchers said.
Yet they found potential overtesting of lipids, full blood count, liver function, and thyroid function.
Testing increased with age and comorbidity, and appeared higher among Asian people and lower among Black people compared with white people, they reported.
The fact that testing rates seemed to be fairly stable compared with data from the previous couple of decades suggests there may be increasing awareness about the appropriateness of testing, the researchers noted.
But the variation at the practice level as well as the finding that some tests were ordered less often than would be recommended by the current guidelines and some more often, points to a lack of clarity or clear communication about the evidence for monitoring, they added.
More evidence is needed on patient outcomes and costs to determine the optimum testing levels, the team concluded as well as an understanding of the acceptability of testing frequencies to patients and health professionals.
Study author Dr Jessica Watson, a GP and NIHR academic clinical lecturer in the Centre for Academic Primary Care at Bristol, said the study was exploratory so did not look into why exactly tests were being done but the results suggested there was quite a lot of variation.
‘I think it would be really helpful to have guidelines on appropriate testing intervals.
‘The thing that’s missing is what are the outcomes for patients, what are the best tests to use in chronic conditions, how frequently we should be testing patients and how can we standardise that between practices and between regions.’
She added that a previous paper a few years ago in the BMJ had suggested a marked increase in use of testing so ‘to see that perhaps flattening off is quite interesting’.
Earlier this week, the health secretary announced that the Government will set out a strategy to tackle six long-term health conditions which it has identified as contributing to England’s ‘burden of disease’, including cancers; cardiovascular diseases, including stroke and diabetes; chronic respiratory diseases; dementia; mental ill health; and musculoskeletal disorders.