20 Chapter 1 endoscopy (37-54% overuse) and colonoscopy (52% overuse). Besides, an increase in overuse of CT and MRI scans for headaches was seen in the United States [51]. Table 2. Roles of a new test compared to an existing test Role Explanation Examples Triage The new test is intended to be used before the existing test, and the existing test is then solely offered to patients with a specific result on the new test. The new test may have reduced accuracy compared to the existing test, but it can offer other advantages such as less burden or costs. Screening all persons aged 55-75 years for faecal occult blood. Only those who have a positive test will receive colonoscopy Replacement The new test is intended to replace the existing test when it is more accurate or offers other advantages (such as reduced burden or costs) compared to the existing test. Magnetic resonance imaging (MRI) instead of mammography in women suspected of having familial breast cancer Polymerase chain reaction testing to detect herpes simplex virus instead of viral culture Add-on The new test is intended to be performed after the existing test, which restricts the test’s application to a subset of people, for instance those who evaluate positive on the existing test. Implementing the new test may increase the accuracy of the testing pathway, but it could also have drawbacks such as increased burden and costs. Positron emission tomography (PET) in patients with cancer after having a negative computed tomography (CT) scan for metastases Parallel/ combined The new test is intended to be used together with an existing test. Determination of eGFR and albumin creatinine ratio to diagnose chronic kidney disease Healthcare spending on laboratory diagnostics among both American and German oncologists and cardiologists was investigated by Rohr et al. They found that laboratory diagnostics accounted for 2.3% and 1.4% of healthcare spending in the United States and Germany respectively, influencing 64% and 67% of clinical decisions [52]. Incorrect testing can result in high healthcare costs, and in unnecessary test burden and anxiety [53]. Physicians acknowledge that unnecessary testing is a significant problem. Reasons for unnecessary test ordering include concerns of liability, providing reassurance, patient demands, keeping patients satisfied, and insufficient time to consult with patients. Most physicians have a sense of responsibility to prevent unnecessary testing. A majority of physicians also state that providing evidence-based recommendations in a format intended for patient communication (e.g. with icon arrays or graphs), would be effective in reducing unnecessary testing [54].
RkJQdWJsaXNoZXIy MTk4NDMw