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Inappropriate use of laboratory tests: How availability triggers demand - Examples across Europe.
Mrazek, Cornelia; Simundic, Ana-Maria; Salinas, Maria; von Meyer, Alexander; Cornes, Michael; Bauçà, Josep Miquel; Nybo, Mads; Lippi, Giuseppe; Haschke-Becher, Elisabeth; Keppel, Martin H; Oberkofler, Hannes; Felder, Thomas K; Cadamuro, Janne.
Afiliación
  • Mrazek C; Department of Laboratory Medicine, Paracelsus Medical University Salzburg, Salzburg, Austria.
  • Simundic AM; Department of Medical Laboratory Diagnostics, University Hospital Sveti Duh, Zagreb, Croatia; Faculty of Pharmacy and Biochemistry, University of Zagreb, Croatia.
  • Salinas M; Clinical Laboratory, Hospital Universitario de San Juan, San Juan de Alicante, Alicante, Spain.
  • von Meyer A; Institute of Laboratory Medicine, Kliniken Nordoberpfalz AG and Klinikum St. Marien, Weiden and Amberg, Germany.
  • Cornes M; Biochemistry Department, Worcester Acute Hospitals NHS Trust, Worcester, UK.
  • Bauçà JM; Department of Laboratory Medicine, Hospital Universitari Son Espases, Palma, Spain.
  • Nybo M; Dept. of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark.
  • Lippi G; Section of Clinical Biochemistry, University Hospital of Verona, Verona, Italy.
  • Haschke-Becher E; Department of Laboratory Medicine, Paracelsus Medical University Salzburg, Salzburg, Austria.
  • Keppel MH; Department of Laboratory Medicine, Paracelsus Medical University Salzburg, Salzburg, Austria.
  • Oberkofler H; Department of Laboratory Medicine, Paracelsus Medical University Salzburg, Salzburg, Austria.
  • Felder TK; Department of Laboratory Medicine, Paracelsus Medical University Salzburg, Salzburg, Austria.
  • Cadamuro J; Department of Laboratory Medicine, Paracelsus Medical University Salzburg, Salzburg, Austria. Electronic address: j.cadamuro@salk.at.
Clin Chim Acta ; 505: 100-107, 2020 Jun.
Article en En | MEDLINE | ID: mdl-32084382
INTRODUCTION: The appropriate use of laboratory diagnostics is increasingly at stake. The aim of this study was to depict some paradigmatic examples of under- and overutilization, as well as possible solutions across Europe. METHODS: We collected six examples from five European countries where a rise or decline of orders for specific laboratory parameters was observed after organizational changes but without evidence of changes in patient collective characteristics as source of this variation. RESULTS: The collected examples were the following: 1-Germany) Switch from a Brain-Natriuretic-Peptide assay to NT-pro Brain-Natriuretic-Peptide assay, resulting in a 374% increase in these analytics; 2-Spain) Implementation of a gatekeeping strategy in tumor marker diagnostics, resulting in a 15-61% reduction of these diagnostics; 3-Croatia) Stepwise elimination of creatine-kinase-MB assay from the laboratory portfolio; 4-UK) Removal of γ-glutamyl transferase from a "liver function" profile, resulting in 82% reduction of orders; 5-Austria) Implementation of a new device for rapid Influenza-RNA detection, resulting in a 450% increase of Influenza testing; 6-Spain) Insourcing of 1,25-(OH)2-Vitamin D measurements, leading to a 378% increase of these analyses. CONCLUSION: The six paradigmatic examples described in this manuscript show that availability of laboratory resources may considerably catalyze the demand, thus underscoring that inappropriate use of laboratory resources may be commonplace in routine laboratories all across Europe and most probably beyond. They also demonstrate that the application of simple strategies may assist in overcoming this issue. We believe that laboratory specialists need to refocus on the extra-analytical parts of the testing process and engage more in interdisciplinary patient-care.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Técnicas de Laboratorio Clínico / Pruebas Diagnósticas de Rutina / Prescripción Inadecuada Tipo de estudio: Diagnostic_studies Límite: Humans País/Región como asunto: Europa Idioma: En Revista: Clin Chim Acta Año: 2020 Tipo del documento: Article País de afiliación: Austria Pais de publicación: Países Bajos

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Técnicas de Laboratorio Clínico / Pruebas Diagnósticas de Rutina / Prescripción Inadecuada Tipo de estudio: Diagnostic_studies Límite: Humans País/Región como asunto: Europa Idioma: En Revista: Clin Chim Acta Año: 2020 Tipo del documento: Article País de afiliación: Austria Pais de publicación: Países Bajos