Peter MacIsaac wrote:
... there has been a steady increase in the cost of radiology
services over recent years.
A related increase in pathology testing has attracted considerable
attention in the Melbourne Age newspaper over the last few days, see:
http://tinyurl.com/fxq2t
http://tinyurl.com/mekc4
http://tinyurl.com/zbtew
The editorial (The Age 6/3) mentioned that the Federal government had
commissioned a report to investigate why test volumes are increasing.
Ironically, many such reports have been commissioned in the past and the
reasons for increasing test volumes are well known. Some of these are
justified, for example genuine advances in diagnostic testing, greater
use of tests to appropriately monitor potentially dangerous treatment
and an aging (and increasingly obese) population with more chronic disease.
Other causes are more dubious such as "defensive" ordering for perceived
medico-legal reasons, thoughtless ordering encouraged by computerised
"tick-box" forms (the paper version of which used to be banned) and
"vertical integration" of companies owning pathology, radiology, GP
clinic and hospital businesses (which may stimulate over-ordering to
increase profit).
However, a major problem identified by previous reports is enormous
variation in how pathology tests are currently used and lack of clear
guidance for clinicians as to which tests are most cost-effective for
investigating or managing particular clinical problems (and how
frequently monitoring tests should be repeated).
To date, the Federal government has focused on supply-side interventions
in an attempt to contain escalating test volumes, reducing pathology
fees if test target volumes were exceeded. However, clinicians, not
pathologists, order the tests. Many reports have suggested that the
Royal Australian College of Pathologist's, "Manual of Use and
Interpretation of Pathology Tests" (funded by the Federal Government)
needs much more material on what tests are cost-effective for
investigating common clinical problems in addition to how much blood or
urine to collect. Furthermore, targeted education and incentives are
needed if GPs are to order tests appropriately. Such programs in New
Zealand are said to have virtually flat-lined "growth" in pathology
testing (see below).
For those interested, I have reviewed the history of pathology policy in
a lecture available at: http://www.medreach.com.au/downloads.htm#Pathology
What do others think about how best to achieve, "best-practice"
pathology ordering?
Cheers
Ken
--
Dr. Ken Harvey
Adjunct Senior Research Fellow
School of Public Health, La Trobe University
http://www.medreach.com.au
VOIP: +61 (03) 9029 0634; Mobile +61 (04) 1918 1910
-------- Original Message --------
Subject: Re: [Haianz] Doctors to be queried over surge in lab tests
Date: Mon, 06 Mar 2006 06:33:55 +1100
From: Ken Harvey <[EMAIL PROTECTED]>
To: HAIANZ <[EMAIL PROTECTED]>
Les Toop wrote:
> Without wishing to brag the 200 GTPs in CHCH have held lab expenditure
> flat for a decade with huge effort into evidence based education..
[snip]
Les, can you tell us more about how you "flat-lined" lab expenditure in
N.Z.?
Cheers
Ken
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-------- Original Message --------
Subject: CHCH programme
Date: Mon, 06 Mar 2006 11:44:54 +1300
From: Les Toop <[EMAIL PROTECTED]>
To: Ken Harvey <[EMAIL PROTECTED]>
Same way we did with drugs, a mixture of small group peer led education
programmes, practice visits, case studies, distributing summarised
evidence, utilisation feedback, changed the lab form and importantly
incentivised the GPs by allowing them to decide how the savings are
spent on other patient services (eg subsidised smoking cessation,
subsidised palliative care at home, extended care at home, special
situation benefits, free contraceptive care for under 20s mammograms
prior to the national programme etc etc.
It really isn't rocket science, but persuading the funders to allow that
level of autonomy is difficult with those who stand to lose undermine
the process at every opportunity.
Les
Les Toop
Professor of General Practice
Head of Department of Public Health and General Practice
Christchurch School of Medicine and Health Sciences
PO Box 4345
Christchurch, New Zealand
Tel 0064 (0)3 3643604
Fax 0064 (0)3 3643637
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