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Can Fam Physician. 2015 Mar;61(3):256-62.

Test ordering for preventive health care among family medicine residents.

Author information

1
Family physician and former resident at the University of Alberta in Edmonton.
2
Associate Professor at McMaster University in Hamilton, Ont.
3
Professor and Chair in the Discipline of Family Medicine at Memorial University of Newfoundland in St John's.
4
Physician based at McMaster University and the University of Toronto in Ontario and a former resident at McMaster University.
5
Family and emergency physician and former resident at the University of Calgary in Alberta.
6
Statistician with the Alberta Research Centre for Health Evidence at the University of Alberta.
7
Professor and Director of Evidence-Based Medicine in the Department of Family Medicine at the University of Alberta. michael.allan@ualberta.ca.

Abstract

OBJECTIVE:

To determine which screening tests family medicine residents order as part of preventive health care.

DESIGN:

A cross-sectional survey.

SETTING:

Alberta and Ontario.

PARTICIPANTS:

First- and second-year family medicine residents at the University of Alberta in Edmonton, the University of Calgary in Alberta, and McMaster University in Hamilton, Ont, during the 2011 to 2012 academic year.

MAIN OUTCOME MEASURES:

Demographic information, Likert scale ratings assessing ordering attitudes, and selections from a list of 38 possible tests that could be ordered for preventive health care for sample 38-year-old and 55-year-old female and male patients. Descriptive and comparative statistics were calculated.

RESULTS:

A total of 318 of 482 residents (66%) completed the survey. Recommended or appropriate tests were ordered by 82% (for cervical cytology) to 95% (for fasting glucose measurement) of residents. Across the different sample patients, residents ordered an average of 3.3 to 5.7 inappropriate tests per patient, with 58% to 92% ordering at least 1 inappropriate test per patient. The estimated average excess costs varied from $38.39 for the 38-year-old man to $106.46 for the 55-year-old woman. More regular use of a periodic health examination screening template did not improve ordering (P = .88).

CONCLUSION:

In general, residents ordered appropriate preventive health tests reasonably well but also ordered an average of 3.3 to 5.7 inappropriate tests for each patient. Training programs need to provide better education for trainees around inappropriate screening and work hard to establish good ordering behaviour in preparation for entering practice.

PMID:
25767171
PMCID:
PMC4369624
[Indexed for MEDLINE]
Free PMC Article

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