Can physician laboratory-test requests be influenced by interventions?

BACKGROUND: Laboratory tests affect healthcare costs and unnecessary test requests can thus be a concern. We studied whether it was possible to influence physician laboratory-test requests using four structured interventions: introduction of clinical guidelines, education, feedback, and reminder letters. The interventions occurred at different times at Landspítali University Hospital, Reykjavik, Iceland. Akureyri Hospital, northern Iceland, was used as a control, since no formal interventions were introduced there. MATERIALS AND METHODS: Six types of laboratory tests were analyzed. The relative risk of a laboratory test being conducted at Landspítali University Hospital compared to Akureyri Hospital was calculated for various points in time, as well as the associated 95% confidence intervals. The primary estimates compare the pre- and post-intervention periods (2007-2009 vs. 2010-2013), but also on a monthly basis in order to observe the trends in greater detail. RESULTS: Interventions at Landspítali University Hospital led to a significant reduction in the average number of laboratory tests (12-52%, p < 0.001) compared with Akureyri Hospital. Relative risk coefficients of laboratory tests at Landspítali University Hospital (LUH) compared to Akureyri Hospital (AH) were calculated pre- and post-guidelines, the relative risk for ASAT, CRP and GGT fell markedly, while ALAT and ALP tests did not show a significant decrease. Relative risk for a blood culture test in the period after the guidelines was statistically significantly increased. CONCLUSION: It is possible to influence physician laboratory-test requests using multifaceted interventions that include continuous monitoring and follow-up.

Disease-Related Knowledge and Need for Revision of Care for Patients with Atrial Fibrillation: A Cross Sectional Study.

Purpose: To evaluate the disease-related knowledge of outpatients with atrial fibrillation (AF), and the relationship with health literacy and other background variables. Patients and Methods: In this cross-sectional survey study, conducted in Iceland, patients with AF scheduled for an electrical cardioversion or AF catheter ablation were recruited from a hospital outpatient clinic. They completed the validated Atrial Fibrillation Knowledge Scale (AFKS), a 11-item instrument (with possible score 0-10, 10 being the best knowledge) which evaluates knowledge pertaining to AF in general, AF symptom detection and AF treatment. Health literacy was assessed with the 16 item European Health Literacy Survey Questionnaire (HLS-EU-Q) and patients answered questions about their background. Data was analysed with parametric tests. Results: In total, 185 participants completed the questionnaire (mean age 63 ±10), 77% were male, 74% with previous electrical cardioversion and 76% were on non-vitamin K antagonist oral anticoagulants (NOAC) medication. The mean score on the AFKS was 6.5 (±1.8). The best knowledge was concerning oral anticoagulation therapy (96% answered correctly) and the least knowledge was regarding responses to AF episodes (17% answered correctly). Patients with sufficient health literacy (52%) had better knowledge of AF (M 6.8 ±1.7 vs M 6.3 ±1.9, p = 0.05). Age, educational level, health literacy and AF pattern explained 22% of the variance in AF knowledge. Conclusion: Patients with AF have inadequate knowledge of their condition, potentially as a result of insufficient health literacy. AF knowledge may be improved using integrated management where patients are actively involved in the care and health literacy is considered in the provided patient education.