None listed
Conditions
Brief summary
The aim of this study is to estimate the effectiveness of feedback for reducing pathology test requesting in general practice compared with control. A secondary aim is to evaluate which forms of feedback are most effective in reducing pathology test requesting.
Interventions
General practitioners (GPs) allocated to the control group will not receive any active intervention during the trial.
GPs allocated to one of eight intervention groups will receive individualised written performance feedback on their pathology test combination requesting rates from the Chief Medical Officer of Australia. The feedback provided to all intervention groups will be consistent in content and length other than three potential effect modifiers to be evaluated in the trial: (1) opportun
General practitioners (GPs) allocated to the control group will not receive any active intervention during the trial. GPs allocated to one of eight intervention groups will receive individualised written performance feedback on their pathology test combination requesting rates from the Chief Medical Officer of Australia. The feedback provided to all intervention groups will be consistent in content and length other than three potential effect modifiers to be evaluated in the trial: (1) opportunity of Continuing Professional Development (CPD)-accredited online educational webinar and self-audit activity aimed at improving pathology requesting (no vs. yes); (2) provision of pathology test cost information (no vs. yes); and (3) feedback format (letter vs. pamphlet). The feedback will be delivered by mail and present the recipients’ rate of requesting of targeted combinations of pathology tests compared with the median request rate of their GP peers in the same geographic stratum. The targeted test pathology combinations are: 1. Iron studies (66596), Thyroid Stimulating Hormone (TSH) (66716) and Vitamin D (66833); 2. Iron studies (66596), Vitamin D (66833) and Vitamin B12 (66838/66839); 3. Iron studies (66596), TSH (66716) and Vitamin B12 (66838/66839); 4. Iron studies (66596), Thyroid Function Tests (TFT) (66719) and Vitamin B12 (66838/66839); 5. Iron studies (66596), TFT (66719) and Vitamin D (66833); 6. TSH (66716) and Vitamin D (66833) and Vitamin B12 (66838/66839); 7. Iron studies (66596) and Vitamin D (66833); 8. Iron studies (66596) and Vitamin B12 (66838/66839); 9. Iron studies (66596) and TFT (66719); 10. TSH (66716) and Vitamin D (66833). Performance feedback will be provided for up to three pathology test combinations where the recipient’s requesting rate is higher than 90% of their GP peers practicing in a similar geographic region. Purpose of the intervention: To reduce overuse of pathology test combination requests by high-requesting GPs Materials: 4-page feedback report and CPD-accredited educational activities (1 hour online webinar and self-directed audit activity) Provider: Australian Government Department of Health Mode of delivery: Feedback letter mailed to participants at their nominated mailing address. Educational activities to be accessed online. Tailoring: Feedback on pathology test combination request rate will be individualised to the recipient. Educational activities will be standard for all recipients. Fidelity: Return to sender to be documented for mailed feedback. Participation in educational activities to be documented.
Sponsors
Australian Government Department of Health
Study design
Allocation
Randomised controlled trial
Intervention model
Factorial
Primary purpose
Educational / counselling / training
Masking
Blinded (masking used) (Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
General practitioners (GPs) practising in Australia, who are in the top 10% of GP referrers overall for 10 targeted combinations of pathology tests and in the top 10% of referrers for at least 2 individual test combinations. Targeted combinations of pathology tests are: 1. Iron studies (66596), TSH (66716) and Vitamin D (66833); 2. Iron studies (66596), Vitamin D (66833) and Vitamin B12 (66838/66839); 3. Iron studies (66596), Thyroid Stimulating Hormone (TSH) (66716) and Vitamin B12 (66838/66839); 4. Iron studies (66596), Thyroid Function Tests (TFT) (66719) and Vitamin B12 (66838/66839); 5. Iron studies (66596), TFT (66719) and Vitamin D (66833); 6. TSH (66716) and Vitamin D (66833) and Vitamin B12 (66838/66839); 7. Iron studies (66596) and Vitamin D (66833); 8. Iron studies (66596) and Vitamin B12 (66838/66839); 9. Iron studies (66596) and TFT (66719); 10. TSH (66716) and Vitamin D (66833). Only pathology tests requests that lead to a service being rendered by a pathologist and for which a Medicare Benefits Schedule (MBS) claim is made are in scope.
Exclusion criteria
1. GPs with <1000 Category 1 services between 1 July 2019 and 30 June 2020, and/or <1000 Category 1 services between 1 July 2020 and 30 June 2021. 2. GPs who did not make any in-scope pathology test requests within the nominated 24-month period (1 July 2019 to 30 June 2021). 3. GPs who participated in user testing of the intervention. 4. GPs who are currently or have been involved in a Department of Health compliance activity commencing on or after 1 May 2021. 5. GPs with a hospital as their primary practice address. 6. GPs with a primary practice address in remote or very remote geographical areas (MM6-7).
Outcome results
None listed