28 de maig 2014

Testing, testing

The Landscape of Inappropriate Laboratory Testing: A 15-Year Meta-Analysis

As a citizen you may be concerned about taxes, as a patient about quality and safety (if you are in a universal publicly funded health care). As both, you should be concerned on cost, quality and access.
Imagine that someone says to you that there is a benefit that is accessible, relatively low cost and at the same time it is ordered but not indicated in 20% of cases, and it is not demanded although necessary in 44% of situations (!). For sure you should be extremely "preoccupied".
The most important difficulty, is that you'll never know that, and this reduces your concerns artificially. If you look at PLOS you'll find such figures from a meta-analysis of last 15 years:

Overall mean rates of over- and underutilization were 20.6% (95% CI 16.2–24.9%) and 44.8% (95% CI 33.8–55.8%). Overutilization during initial testing (43.9%; 95% CI 35.4–52.5%) was six times higher than during repeat testing (7.4%; 95% CI 2.5–12.3%;

Overutilization measured according to restrictivecriteria (44.2%; 95% CI 36.8–51.6%) was three times higher than for permissive criteria (12.0%; 95% CI 8.0–16.0%;P,0.001). Overutilization measured using subjective criteria (29.0%; 95% CI 21.9–36.1%) was nearly twice as high as for objective criteria (16.1%; 95% CI 11.0–21.2%;P=0.004).

With all these statistics together, somebody should do something. The first thing is to know what is happening nearby. Do you know it?

PS. Although this meta-analysis states that underutilization is 44,8%, I would suggest to take caution over this figure. I think that nobody has analysed properly its implications if it were true.

Meanwhile, dancing with Parov Stelar - Shuffle