oa Southern African Journal of Epidemiology and Infection - Doctors' use of laboratory tests in the diagnosis and treatment of patients : original research
The provincial health budgets in South Africa are under enormous pressure and, annually, budgets are exceeded by most hospitals and clinics. Laboratory tests requested by clinicians are contributing to the problem of over-expenditure. The aim of this study was to determine from patients' files whether doctors were using laboratory tests prudently during their treatment of patients in the outpatient department (OPD) of the National District Hospital in Bloemfontein. A descriptive study was carried out using all the files of patients who visited the OPD in a three-month period (1 July to 30 September 2005) for whom laboratory tests were requested by the attending physician. The majority (31.3%) of patients for whom laboratory tests were requested presented to the OPD with cardiovascular complaints or diagnoses, followed by endocrine (27.8%) and musculoskeletal (16.3%) complaints or diagnoses. Between one and three tests were requested for most patients, i.e. 33% and 15%, respectively. The most frequently requested tests were erythrocyte sedimentation rate (8.1%), urea and electrolytes (7.7%), urine microscopy, culture and sensitivity (6.4%), cholesterol (6.1%), full blood count (5.7%) and thyroid profile (TSH 4.6%, T4 2.6% and thyroid functions 2.3%). In 70.4% of cases, results were documented and, in 59.1%, the physician's management plans indicated the incorporation of laboratory test results into the patient's treatment regimen. Our findings indicated inappropriate documentation and application of test results. Interventions to improve physician behaviour include education, guidelines, feedback, leadership and redesign of requisition forms.
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