Testing 1, 2, 3: Is overtesting undermining patient and system health?

By Margaret J. McGregor and Danielle Martin
Published in Canadian Family Physician, November 2012
Health care costs are rising in Canada, and not mainly because of population aging. One of the fastest growing areas of health services spending is laboratory testing. Laboratory tests are not free. McGrail and colleagues recently demonstrated that in British Columbia (BC), $174 million more was spent on laboratory testing and imaging in 2005 and 2006 compared with 1996 and 1997.1 Research further reports a 37.4% increase in laboratory testing over this time (S. Sivananthan and colleagues, unpublished data, 2012). These increases are even after accounting for population aging and inflation.
Overtesting is a relatively understudied topic, and overuse rates vary by test and by study.2,3 However, as physicians we know that many of the decisions to order tests start in the family doctor’s office.4 Van Walraven and colleagues found that family physicians in Ontario were more than 7 times more likely than specialists to order potentially redundant repeat tests for hemoglobin, sodium, creatinine, thyrotropin, total cholesterol, ferritin, and hemoglobin A1clevels.
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