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. 2021 Dec 3;22(1):242.
doi: 10.1186/s12875-021-01591-w.

Effect of a price display intervention on laboratory test ordering behavior of general practitioners

Dennis M J Muris  1   2 , Max Molenaers  3 , Trang Nguyen  3 , Paul W M P Bergmans  4 , Bernadette A C van Acker  5 , Mariëlle M E Krekels  4   6 , Jochen W L Cals  3
Affiliations

Effect of a price display intervention on laboratory test ordering behavior of general practitioners

Dennis M J Muris et al. BMC Fam Pract. .

Abstract

Background: Redundant use of diagnostic tests in primary care has shown to be a contributor to rising Dutch healthcare costs. A price display in the test ordering system of the electronic health records (EHRs) could potentially be a low-cost and easy to implement intervention to a decrease in test ordering rate in the primary care setting by creating more cost-awareness among general practitioners (GPs). The aim of this study was to assess the effect of a price display for diagnostic laboratory tests in the EHR on laboratory test ordering behavior of GPs in the Westelijke Mijnstreek region in the Netherlands.

Methods: A pre-post intervention study among 154 GPs working in 57 general practices was conducted from September 2019, until March 2020, in the Netherlands. The intervention consisted of displaying the costs of 22 laboratory tests at the time of ordering. The primary outcome was the mean test ordering rate per 1.000 patients per month, per general practice.

Results: Test ordering rates were on average rising prior to the intervention. The total mean monthly test order volume showed a non-statistically significant interruption in this rising trend after the intervention, with the mean monthly test ordering rate levelling out from 322.4 to 322.2 (P = 0.86). A subgroup analysis for solely individually priced tests showed a statistically significant decrease in mean monthly test ordering rate after implementation of the price display for the sum of all tests from 67.2 to 63.3 (P = 0.01), as well as for some of these tests individually (i.e. thrombocytes, ALAT, TSH, folic acid). Leucocytes, ESR, vitamin B12, anti-CCP and NT-proBNP also showed a decrease, albeit not statistically significant (P > 0.05).

Conclusions: Our study suggests that a price display intervention is a simple tool that can alter physicians order behavior and constrain the expanding use of laboratory tests. Future research might consider alternative study designs and a longer follow-up period. Furthermore, in future studies, the combination with a multitude of interventions, like educational programs and feedback strategies, should be studied, while potentially adverse events caused by reduced testing should also be taken into consideration.

Keywords: Diagnostic tests; Healthcare costs; Primary care; Test ordering rate.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Display price information at the time of ordering in the Cyberlab laboratory test ordering screen
Fig. 2
Fig. 2
Mean monthly number of laboratory tests ordered per general practice, per 1.000 patients (95% CI)
Fig. 3
Fig. 3
Mean monthly number of individually prized laboratory tests ordered, per general practice, per 1.000 patients (95% CI)
Fig. 4
Fig. 4
Per-test mean monthly number of laboratory tests ordered, per general practice, per 1.000 patients (95% CI), ranked by ascending costs
See this image and copyright information in PMC

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