Table 1 Overview of intervention characteristics and results
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 12Â months post-intervention | 18Â % 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 | 12Â months pre- and 12Â months post-intervention (data on test requests for randomly selected 30Â days in each period) | 5Â % reduction in the volume of tests requested by the intervention district 1Â year following the intervention (retrospective audit) compared with a 1Â % 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 | 6Â months pre- and 6Â months post-intervention | 12Â % reduction in volume of total tests in intervention group versus no change in control arm. 16Â % 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 1Â year) | 38 GPs (16 practices) received guidelines then feedback about lipid and plasma viscosity tests (each a control group for the other) | Baseline and 1Â 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 | 2Â years pre- and post-intervention | 60Â % reduction in number of ESR tests by the intervention group following the intervention versus an 18Â % reduction in comparison doctors after intervention |