Evaluation of PSA testing by general practitioners: regional study in the autonomic Community of Valencia.

OBJECTIVES: The aim of the study is to compare the use of PSA testing among general practitioners (GPs). METHODS: The number of PSA tests ordered by general practitioners in the years 2008-2009 was examined in a cross-sectional study of nine health districts of Spain. The percentage of PSA ordered to men younger than 50 (PSA<50/PSAtotal) and 40 years (PSA<40/PSAtotal) was calculated. The percentage of men over 50 years who were attended was also calculated and this data was compared with the number of PSA ordered to this population. For two of the departments, these data were also compared between GPs and urologists. RESULTS: PSA testing in 2009 is higher than 2008 in seven health districts. PSA testing in men younger than 50 years was increased along the period of the study and in men younger than 40 years remained steady. The differences between the values of the indicators for urologists and GPs are significant. CONCLUSIONS: The number of PSA tests and the percentage performed to men younger 50 years has been increasing and the variability is high. These data are suggestive for interventions focused on PSA testing and prostate cancer screening in primary care settings.

Regional variations in test requiring patterns of general practitioners in Spain.

OBJECTIVE: To analyze the requesting patterns for a range of laboratory tests ordered in 2009 from eight laboratories providing services to eight health areas, using appropriate indicators. DESIGN: Indicators measured every test request per 1,000 inhabitants, and indicators that measured the number of tests per related test requested by general practitioners were calculated. The savings generated, if each Health Care Department achieved the appropriate indicator standard, were also calculated. Laboratory Information System registers were collected, and indicators were calculated automatically in each laboratory using a data warehouse application. RESULTS: There was a large difference in demand for tests by health areas. The ratio of related tests also showed a great variability. The savings generated if each Health Care Department had achieved the appropriate indicator standard were €172,116 for free thyroxine, €18,289 for aspartate aminotransferase, and €62,678 for urea. CONCLUSIONS: Considerable variability exists in general practitioners' demand for laboratory tests.

[An evaluation of glycosylated hemoglobin requesting patterns in a primary care setting: a pilot experience in the Valencian Community (Spain)]. / Evaluación del patrón de solicitud de hemoglobina glucosilada por Atención Primaria: estudio piloto regional en la Comunidad Valenciana.

OBJECTIVE: To assess the pattern of glycosylated hemoglobin (HbA(1c)) requests by clinicians from eight health departments by calculating indicators of demand appropriateness. METHODS: A cross-sectional study of the number of HbA(1c) requests by primary care clinics in 2008 and 2009. The indicator of demand appropriateness was the proportion of HbA(1c) values lower than 6.5%. Variables were collected and indicators were automatically calculated. The number of HbA(1c) measurements that should theoretically have been requested according to known diabetes prevalence data was also calculated. RESULTS: A progressive increase was seen in demand for HbA(1c) measurements. Approximately 54% of HbA(1c) values obtained in seven of the eight departments studied were lower than 6.5%. The number of theoretical HbA(1c) requests that would have been expected based on the known prevalence of diabetes was higher than the number of HbA(1c) requests in all departments. CONCLUSION: The results appear to suggest that HbA(1c) requests by the health departments studied were not always appropriate. HbA(1c) measurements were probably overused in patients without diabetes and underused in patients with diabetes.