The Quality Use of Pathology Program (QUPP) has investigated ways to promote evidence-based practice of pathology through 16 projects (Table 2). While pathology, by its nature, is an evidence-based discipline, the quality use of pathology is best served when diagnostic decisions by treating practitioners are also based on sound medical evidence. To devise strategies to promote this outcome, existing databanks of pathology ordering patterns and their impact on patient outcomes must be broken down and analysed, the use of technology to support better diagnostic outcomes explored and the use and awareness of existing resources and best-practice evidence-based information to support diagnostic decisions must be made available to treating practitioners.
Medical schools are also pivotal to evidence-based practice in pathology requesting as new generations of medical practitioners emerge with more information and resources available to inform their practice than their predecessors. This can also be a hindrance to their practice as information ‘overload’, the lack of time to either access or digest this information and clinical mentoring based on established protocols (which may no longer be informed by best-practice evidence) can influence diagnostic and pathology ordering decisions.
Common issues identified through this integrated analysis included:
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ensuring treating practitioners and medical students were aware of existing evidence-based resources and were utilising them to their full capacity
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incorporating laboratory medicine into the curriculum of medical schools in a meaningful and sustainable way.
Based on these issues, areas for future consideration to promote evidence-based practice focus primarily on information dissemination and strategies to incorporate pathology into the curriculum and teaching practices of medical schools. They include:
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Devise a strategy to ‘remind’ doctors about the existence and usefulness of the Royal College of Pathologists of Australasia (RCPA) Manual at specified time intervals.
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Develop guidelines/protocols for pathology tests for common conditions.
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Develop a framework for decision support for general practitioners (GPs) investigating tiredness in general practice based on elements identified in A Project to Examine the Utilisation of Pathology Tests in the Investigation of Tiredness in General Practice (2002) on page 24.
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Focus on improving the education of medical students in undergraduate training institutions (universities and teaching hospitals) across Australia in laboratory medicine.
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Instigate global guidance by pathologists regarding overall diagnostic testing strategies, especially for junior medical officers (JMOs) in the form of clinical pathways and/or via a consensual approach within clinical teams or units.
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Investigate the viability of placing pathologists in hospital wards to mentor JMOs.
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Investigate the viability of providing detailed audit and feedback regarding test-ordering practices.
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Improve the knowledge base of JMOs through targeted education.
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Develop evidence-based, best practice guidelines for the appropriate use of pathology for GPs.
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Commonwealth investment in National Prescribing Service (NPS) academic detailing strategies for diagnostic services.
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Requester education and decision support guidance statements, especially for the use of the full blood count (FBC), thyroid function tests (TFT), multibiochemical analysis and liver function tests in monitoring chronic disease.
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Liaise with National Health and Medical Research Council (NHMRC)/guideline developers regarding:
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adding an ‘investigations’ section into guidelines
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standardising pathology terminology
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including pathology representation on guideline development working groups.
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Explore the use of online tools for training and support of quality pathology.
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Explore how the Royal Australian College of General Practitioners (RACGP) and the Royal College of Pathologists of Australasia (RCPA) can work together to integrate and enhance the utility of the Pathology Decision Support Tools (PDSTs) to the clinical practice of requesters such as an accessible link to the RCPA Manual via GP’s desktops.
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Possible development of a standardised reporting format for all major cancers and other major complex reporting topics
[alt = “The following table lists the sixteen project names and grant recipients under the Promoting Evidence Based Practice theme”]
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Project Name
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Grant Recipient/s
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1
|
|
Healthcare Management Advisors
|
2
|
|
Royal College of Pathologists of Australasia (RCPA)
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3
|
|
RCPA
|
4
|
An Historical Analysis of Pathology Ordering by General Practitioners between April 1998 and March 2001 from the Bettering the Evaluation and Care of Health (BEACH) Program (2002)
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University of Sydney
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5
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Evidence-Practice Gap in GP Pathology Test Ordering: A Comparison of BEACH Pathology Data and Recommended Testing (2009)
|
University of Sydney
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6
|
A Project to Examine the Utilisation of Pathology Tests in the Investigation of Tiredness in General Practice (2002)
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Luminis Pty Ltd
|
7
|
Analysis of Current Practices in Relation to the Teaching of Pathology (Laboratory Medicine) (2003)
|
Healthcare Management Advisors
|
8
|
Analysis of Current Laboratory Medicine (Pathology) Teaching Practice in Prevocational and General Practitioner Vocational Training (2003)
|
Healthcare Management Advisors
|
9
|
A Mechanism for the Development, Implementation and Evaluation of Evidence-Based, Best-Practice Clinical Guidelines to Facilitate Quality Use of Pathology Tests (2003)
|
Therapeutic Guidelines Ltd
|
10
|
Academic Detailing Supporting Better Outcomes from Diagnostic Technologies (2004)
|
Drug and Therapeutics Information Service (DATIS)
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11
|
Common Sense Pathology (2006)
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RCPA
|
12
|
Common Sense Pathology Publication Series (2011)
|
RCPA
|
13
|
Improved Pathology Reporting, Education and Practice (IPREP) for Colorectal Cancer (2009)
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University of NSW
|
14
|
Structured Pathology Reporting Standards for Cancer (2009)
|
Cancer Institute NSW
|
15
|
Promoting and Expanding Structured Pathology Reporting of Cancer (Stage 2) (Current)
|
RCPA
|
16
|
Evidence-Based, Best-Practice Prevention of Blood Borne Virus Transmission in Health Care Settings Program (PBBV) (2009)
|
South Eastern Area Laboratory Service (SEALS)
|
Table 2: Reports summarised for Promoting Evidence-Based Practice
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