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Órgano oficial de difusión de la Federación Mexicana de Patología Clínica, AC y de la Asociación Latinoamericana de Patología Clínica/Medicina de Laboratorio

2003, Number 4

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Rev Mex Patol Clin Med Lab 2003; 50 (4)

Inappropriate utilization of the clinic laboratory

Barba EJR

Language: Spanish
References: 30
Page: 209-223
PDF size: 109.07 Kb.


ABSTRACT

Currently, the facility to count with advanced technological resources, mainly when those are applied to the field of medicine, have propitiated that the physician forgets about the essence of the clinic, requiring, in order to reach to a diagnostic conclusion, the use of increasing number of tests that in the past were considered aids to a diagnostic and which nowadays, being requested in an indiscriminate way, provokes their own sober utilization. This over utilization causes bad handling of test, although approximately 20% are unnecessary. It is very important to create conscience that the inadequate use of laboratory can provoke lost of funds, in the case of public institutions of this country generates that the budget becomes deficient. The present work has an objective to review the different clinical studies that show that it is possible to reduce the utilization of laboratory tests, without decreasing the quality of medical attention, generating savings in money as well as in laboratory resources.


REFERENCES

  1. Frances TF. Manual de pruebas diagnósticas. 5a ed. McGraw-Hill Interamericana, 1996: 1-23.

  2. Solomon DH et al. Techniques to improve physicians’ use of diagnostic test: A new conceptual framework. JAMA 1998: 280 (23): 2020-2027.

  3. Deyo AR. Cascade effects of medical technology. An Rev Pub Health 2002; 23: 23-39.

  4. Bernard HJ. Diagnóstico y tratamiento clínicos por el laboratorio. 9a ed. Masson-Salvat, 1993: 3-28.

  5. Tierney MW et al. The effect on test ordering of informing physicians of the charges for outpatient diagnostic test. N Engl J Med 1990; 322: 1499-1504.

  6. 6 Sanford SJ. Comprensión de los resultados de las pruebas de laboratorio. Condiciones ideales para uso de pruebas de laboratorio. Clin Med Norteam Pract Lab Med 1987; 4: 647-661.

  7. Lundberg GD. The Need for an Outcomes Research Agenda for Clinical Laboratory Testing. JAMA 1998; 280 (6): 565-566.

  8. Statland BE et al. Repaso de la utilización y administración de pruebas de laboratorio en consulta externa. Clin Med Norteam Pract Lab Med 1987; 4: 733-746.

  9. Van Walraven C et al. Do we know what inappropriate laboratory utilization is? A systematic review of laboratory clinical audits. JAMA 1998; 280 (6): 550-558.

  10. Bareford D et al. Inappropriate use of Laboratory services: long term combined approach to modify request patterns. BMJ 1990; 301: 1305-1307.

  11. Durand ZI et al. Reducing unnecessary laboratory use with new test request form example of tumor markers. Lancet 1993; 342: 150-153.

  12. Schoenenberger RA et al. Appropriateness of antiepileptic drug level monitoring. JAMA 1995; 274 (20): 1622-1626.

  13. Commentary. Testing for uncommon conditions. The heroic search for positive test results. Arch Intern Med 1990; 150: 2451-2458.

  14. Frankel HL et al. Minimizing admission laboratory testing in trauma patients: Use of a microanalyzer. J Trauma 1994; 37 (5): 728-736.

  15. Jacobs IA et al. Cost savings associated with changes in routine laboratory test ordered for victims of trauma. Am Surgeon 2000; 66 (6): 579-584.

  16. Chu UB et al. The Impact of selective laboratory evaluation on utilization of laboratory resources and patient care in a Level-1 Trauma Center. Am J Surg 1996; 172: 558-563.

  17. Rodriguez PL et al. Utilidad de los exámenes de laboratorio y gabinete en un servicio de urgencias. Rev Med IMSS 1992; 30: 93.

  18. Scholer SJ et al. Effect of health care system factors on test ordering. Arch Pediatr Adolesc Med 1996; 150: 1154-1159.

  19. Petersdorf RG et al. Principios de medicina interna. 10a ed. Tomo I. Mc Graw Hill, 1993: 3-4.

  20. Waise A et al. Which surrogate marker can be used to asses the effectiveness of the laboratory and its contribution to clinical outcome? Ann Clin Biochem 2001; 38 (6): 589-596.

  21. McQueen MJ. Evidence-Based Medicine: Its application to laboratory medicine. Therap Drug Monit 2000; 22 (1): 1-9.

  22. Marcello WP et al. Estudios preoperatorios “de rutina”. Selección de los más adecuados para el paciente idóneo. Clin Quirur Norteam 1996, 11: 11-22.

  23. Macpherson VV. The value of routine preoperative laboratory testing in predicting postoperative complications: A multivariate analysis. Surgery 1991; 109: 236-243.

  24. Macpherson DS et al. Preoperative screening: Value of previous tests. Ann Intern Med 1990; 113: 969-973.

  25. Galloway M et al. Benchmarking and the laboratory. J Clin Pathol 2001; 54 (8): 590-601.

  26. Bush TM et al. Serum complements. Inappropriate use in patients with suspected rheumatic disease. Arch Intern Med 1993; 153: 2363-2366.

  27. Siegel DL et al. Inappropriate testing for diarrheal diseases in the hospital. JAMA 1990; 263 (7): 979-982.

  28. Dubin CG. Guideline process improves laboratory use and costs. Crit Care Med 1997; 25 (8): 1262-1263.

  29. Flabouris A et al. Routine blood test ordering for patients in intensive care. Anaesth Intens Care 2000; 28 (5): 562-567.

  30. Winkens RAG et al. Effect of feedback on test ordering behaviour of general practitioners. BMJ 1992; 304: 1093-1096.




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