Evaluation of the Impact on Pathology Practice of the Manual of Use and Interpretation of Pathology Tests (2001)
Description
This project sought to evaluate the effectiveness of the Manual of Use and Interpretation of Pathology Tests as a resource in Australia. The Manual was first produced in 1990 by the Royal College of Pathologists of Australasia (RCPA) under the newly established Pathology Education Program. Its aim was to provide objective clinical guidance to requesting medical practitioners on the most appropriate tests to use in the diagnosis and/or management of specific medical conditions. The second edition was produced in 1997 (and made available online via the RCPA website – http://www.rcpamanual.edu.au - in 2000) and widely distributed to general practitioners (GPs), interns, residents, registrars and senior medical students. A third edition was released by the RCPA via their website in August 2001.
Grant Recipient
Healthcare Management Advisors
Aims
to gather information as to how widely the Manual has been disseminated, and how GPs and other medical practitioners use it in a variety of settings
to ascertain why GPs may not use the Manual and whether there are more appropriate but alternative means of assisting them to order and interpret pathology tests.
Objectives
to determine the extent to which the Manual was disseminated to GPs, interns, residents, registrars and medical students
to determine to what extent GPs are aware of the Manual
to determine the level of use of the Manual in general practice and public and private hospitals
to determine how GPs use the manual
to determine the extent of the impact of the Manual on pathology test selection and test volume
to determine the impact of the Manual on patient care in both metropolitan and rural settings
to estimate, where possible, the financial impact of the Manual on Medicare and other healthcare costs
to determine why GPs may not use the manual
to discover what information GPs require to help them better order and interpret pathology tests as part of clinical care
to discover how the information should be disseminated.
These aims and objectives were achieved by this project.
Findings
Feedback from 621 GPs (47.8% response rate) indicated that:
use of the Manual (by those who were aware of it) was 86.6%
86% used it in the previous six months and indicated it was a relevant resource
the most important factors influencing use was its ready accessibility (51%) and the information was relevant (48%)
the direct impact of the Manual was very small (0.4% of all pathology tests influenced by the Manual), although it was important for unusual or infrequently ordered tests.
Feedback from 813 hospital doctors (9% response rate) indicated that:
61.5% (500) of respondents were aware of the Manual prior to receiving the questionnaire
awareness by intern year increased from 31% for those who were interns up to 1980, 78% for 1998 (soon after the Manual was released) and 52% in 2001
67% of those aware of the Manual indicated they had used it
the use of the Manual was lowest amongst intern respondents (57.6%) and highest amongst registrars (68.9%) and residents (68.3%)
of those who used the Manual, 32% did so in the previous three to six months, 23% within the last month and 7% within the last week
the Manual was used to directly inform 1.5% of all pathology requests
86% indicated it did not change the numbers of pathology requests, but it did modify the test profile on about 50% of occasions where it was consulted
the Manual was seen as an important reference resource in the hospital environment during the formative early working years in a doctor’s career.
Analysis of ordering patterns via de-identified data from the Health Insurance Commission (HIC) indicated there were three test bundles where the Manual provided specific guidance and allowed analysis:
thyroid function test (TFT)
iron studies versus serum ferritin
extractable nuclear antigen antibodies.
General conclusions were:
doctors who were aware of the Manual accepted it as an important reference resource and continue to use it
doctors supported the development of an updated version
the target population needs to be periodically reminded of its existence through appropriate education forums
hospital doctors would benefit by hospitals developing a link to the Manual on the RCPA website via pathology results reporting systems
future Manuals should be distributed to new medical graduates in each year of currency.
Recommendations
A revised Manual be developed and distributed to GPs and new medical graduates.
Future development and release of the Manual (or equivalent resource) should include periodic (at least annual) distribution to graduating/new-graduate doctors and a reminder sent to all relevant doctors about its existence.
Sufficient copies of any future Manual should be produced to satisfy demand beyond its initial distribution.
Hospitals to be made aware of the RCPA website version of the Manual and encouraged to link it to their pathology reporting system.
Appropriate GP education and initiatives should accompany the distribution of future versions of the Manual.
The future Manual, or similar resources, should be developed in various formats including book/hardcopy and electronic forms and various strategies for disseminations (including associated educational initiatives) be adopted.
Consider linking the development of future versions of the Manual to incorporate the National Association of Testing Authorities (NATA) requirement for laboratories to produce similar resources.
Continue to develop future versions of the Manual in conjunction with the RCPA and other appropriate professional colleges.
Recommendations for future printed versions included:
colour code key selections similar to the Medicare Benefits Schedule (MBS) model
include basic ‘operational’ information such as tube colours, collection procedures etc.
include guidelines/protocols for pathology tests for common conditions
include some information about HIC limitations of tests
include specific information on tests, test frequency, test bundles and acceptable abbreviations for tests
include useful supplementary tests and tests not indicated based on the results
identify ‘normal’ ranges and sensitivity indicators for test results
include turnaround times
consideration of producing the Manual since laboratories produce similar resources under the NATA requirement for accreditation.
Key Project Learnings
The single distribution in 1997 without follow-up reduced awareness levels amongst newly graduated doctors. Only 30% of 2001 interns were aware of and had used the Manual.
Many hospitals produce their ‘own’ version of the Manual setting out ordering practices expected at that hospital.
Providing the Manual in either hard copy or electronic format to all medical student graduates ensures access to the Manual.
The initial component of hospital work (intern and first years post graduation) provided the most important knowledge about pathology ordering as little was incorporated into university education.
It may be more widely used if provided to each ‘ward’ as opposed to each doctor.
