Journal of the Medical Association of Thailand = Chotmaihet thangphaet
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Randomized Controlled Trial Clinical Trial
Laboratory investigation utilization in pediatric out-patient department Ramathibodi Hospital.
Laboratory investigations are inappropriately utilized in the Pediatric OPD of Ramathibodi Hospital and this is due to lack of knowledge and unawareness of the cost of tests. ⋯ 1. The utilization pattern was not correlated to the level of seniority of the physicians. 2. There was inappropriate laboratory utilization in this group of residents: overutilization defined as should not be ordered (26.9%), and underutilization defined as should have been ordered (17.7%). Most of the inappropriateness occurred in the ordering of microbiology (50%) and special blood chemistry (40%). 3. Only the number of tests per patient ordered by the R2I group was significantly lower than that of the R2C group in the late post-intervention period. The cost of tests per patient ordered by the R2C group was significantly increased as compared to their baseline. This suggested that the combination of education, chart audit and active feedback strategies was more effective than each strategy alone. 4. The appropriateness of the test ordering behavior of the resident intervention groups improved during the post-intervention period, although the change was not statistically significant. The control groups' behavior was statistically worse. This suggested that the strategy prevented the inappropriateness of test ordering behavior. 5. With the intervention, the overutilization significantly decreased while the underutilization increased. The underutilization might be a consequence of cost containment on laboratory utilization. 6. The cost of unnecessary tests accounted for 17.6 per cent of the total cost of tests ordered by the residents.