More care is not equivalent to higher-quality care. In fact, unnecessary tests and procedures significantly increase healthcare costs, said Prof. Praveen Sharma, Professor of Biochemistry at the All India Institute of Medical Services, Jodhpur, India, at the Medlab Middle East Congress 2023.
“Laboratory tests are fundamental to medical diagnosis, prognosis, and treatment decisions. However, there is both over-utilisation and underutilisation in laboratories. It is observed that the private sector tends to conduct more tests because testing is a source of revenue. In a lot of cases, the cost of performing tests is significantly less than what is charged. So a private clinic or hospital would understandably like to conduct more tests. But this is an ethical question, why should patients be taxed for this?” Prof. Sharma questioned.
“Take the case of Vitamin D, for instance. The cutoff for Vitamin D is 30, but most people have lower levels of this vitamin. We need an expansive study to understand the reference range for Vitamin D for different regions and countries. It cannot be the same for all. A region-wise reference range could help curb unnecessary test prescriptions for Vitamin D,” Sharma said on the sidelines of his talk on ‘Strategic leadership plan towards improving value-based laboratory utilisation’.
Laboratory testing is the single highest-volume medical activity and drives clinical decision-making across medicine. However, labs globally are plagued with both overutilisation and underutilisation, which affects not only the medical outcome but also a number of other aspects of healthcare. A 15-year meta-analysis by Zhi et al, Prof. Sharma quoted, states that the rate of laboratory overutilisation is 20.6 per cent and underutilisation is close to 45 per cent.
He suggests a five-prong strategy to improve laboratory test utilisation, which includes order entry system, minimum resting intervals, careful design of test panels, reflex and reflective testing, and education and inter-professional dialogues.
“Minimum resting interval is the minimum time before a test should be repeated. It is based on the properties of the test and the clinical situation in which it is used. It can lead to significant savings of time, money and resources for patients and medical professionals,” said Prof. Praveen.
Prof. Praveen also advocated for more careful design of test panels. “One way of reducing unnecessary costs is to restrict usage of low-value tests. The medical community can look at eliminating tests that have no value. For instance, faecal occult blood test has minimal value in acute care. So this can be eliminated as an orderable test in acute care for screening symptomatic individuals. Laboratories should also restrict test orders to specific signs, and symptoms — Vitamin D and B12 need not be ordered for everyone. Labs can also look at substitution of better tests for a less valuable test — CRP over ESR, urine metanephrines over urine catecholamines,” he added.
The laboratories need better communication and collaboration with appropriate clinical leaders to make restrictions successful and reduce the cost of unnecessary healthcare.
Visit Medlab Middle East 2023 to attend thought-provoking sessions led by industry experts from across the globe.
