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Table 1 Overview of intervention characteristics and results

From: The effectiveness of interventions to improve laboratory requesting patterns among primary care physicians: a systematic review

Reference Setting Design Participants Type Intervention Comparator Follow-up Effect of intervention
Horn et al. [17] USA ITS 215 primary care physicians (5 group practices) Changing order form Cost displays within electronic health record at time of ordering (153 physicians) Control group: no cost information (62 physicians) 12 months pre- and 6 months post-intervention Difference-in-difference approach. 1–2.6 % reduction. 20 % The cost displays resulted in a reduction of 0.4–5.6 laboratory orders per 1000 visits per month (p < 0.001)
Kahan et al. [26] Israel CBA Not disclosed Changing order form A new version of electronic order form Older version of computerised order form 6 months pre- and 4 months post-intervention 31–41 % reduction relative to the pre-intervention month, with 36–58 % reduction the following month. −2–3 % changes for control tests
Shalev et al. [27] Israel CBA 865 primary care physicians Changing order form Changing volume of tests on order form (27 tests removed and 2 tests added—reducing the number of tests available using a check-box form from 51 to 26) Standard form prior to intervention 12 months pre- and 24 months post-intervention For deleted tests, there was a 27 % and 19.2 % reduction 1 and 2 years after intervention, respectively
Zaat et al. [46] Netherlands CBA 75 primary care physicians Changing order form Volume of tests on order form reduced (hand written request if test not displayed) (47 physicians) Standard form (28 physicians) Five month pre-intervention (control) and 12 months post-intervention 18 % reduction in number of tests requested monthly in experimental group after the intervention compared to the control doctors
Barrichi et al. [25] Italy CBA 44 primary care physicians Education Pathology-specific laboratory algorithms for 7 common clinical scenarios were tested. Education was provided (8 training sessions) to the physicians about the algorithms and their use (23 physicians) Current practice 12 months pre- and 12 months post-intervention (data on test requests for randomly selected 30 days in each period) 5 % reduction in the volume of tests requested by the intervention district 1 year following the intervention (retrospective audit) compared with a 1 % increase in the control district
Larsson et al. [18] Sweden CBA 63 primary care physicians (19 practices) Education An education programme (2-day lecture series) Current practice (2 practices) 5 months pre-intervention and 4 months post-intervention 7 ratios were recommended to decrease in volume, 5 did at p < 0.05. 7 were expected to increase in volume, 4 did at p < 0.05
Verstappen et al. [21] Netherlands RCT 174 primary care physicians (26 practices) Education A primary care physician-based strategy focused on clinical problems and associated tests (85 physicians in arm a and 89 physicians in arm b) Each group acted as a control for the other 6 months pre- and 6 months post-intervention 12 % reduction in volume of total tests in intervention group versus no change in control arm. 16 % reduction of inappropriate tests for intervention group
van Wijk et al. [22] Netherlands RCT 60 primary care physicians (44 practices) Guidelines Guideline-based order form (29 GPs) versus restricted guideline-based electronic order form (31 GPs) Each group acted as a control for the other Study period: 1 July 1994–30 June 1995 Decision support based on guidelines is more effective in changing blood test ordering than decision support based on initially displaying a limited number of tests. Primary care physicians who used BloodLink-Guideline requested 20 % fewer tests on average than did practitioners who used BloodLink-Restricted (mean (±SD), 5.5 ± 0.9 tests versus 6.9 ± 1.6 tests (p = 0.003))
Baker et al. [23] UK RCT 96 primary care physicians (33 practices) Guidelines and feedback 58 GPs (17 practices) guidelines followed by feedback about the numbers of thyroid function, rheumatoid factor test and urine cultures they ordered (quarterly for 1 year) 38 GPs (16 practices) received guidelines then feedback about lipid and plasma viscosity tests (each a control group for the other) Baseline and 1 year post-intervention No effect. No change in volume of tests per 1000 requested in either of the study groups for any of the tests
Thomas et al. [19] UK RCT 370 primary care physicians (85 practices) Feedback and education Quarterly feedback of requesting rates and reminder messages. Practices allocated to 1 of 4 groups: control (20 practices), enhanced feedback alone (22 practices), reminder messages alone (22 practices) or both enhanced feedback and reminder messages (21 practices) Current practice 12 months pre- and post-intervention 11 % reduction in requests for practices receiving enhanced feedback or reminder messages (OR 0.89, 95 % CI 0.83–0.93) compared with control group
Tomlin et al. [24] New Zealand CBA 3160, 3140 and 3335 primary care physicians Guidelines, feedback and education 3 marketing programmes (guidelines, individual feedback and professional development) Locum and other physicians not targeted by the programmes 2 years pre- and post-intervention 60 % reduction in number of ESR tests by the intervention group following the intervention versus an 18 % reduction in comparison doctors after intervention