ArticleBMJ open2018
Explaining variations in test ordering in primary care: protocol for a realist review.
Article in BMJ open, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 23 papers.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
23 citing papers in PubMed.
- Article
- Medical practice variation in Vietnam: a cross-sectional study.BMC health services research · 2026Article
- Optimising pain management in intensive care setting: Insights from a realist evaluation.International journal of nursing studies advances · 2026Review
- How Cancer Online Support Groups Work, for Whom, and in What Circumstances: Realist Review.Journal of medical Internet research · 2026Review
- The cost of unnecessary test orders: a retrospective study.Malawi medical journal : the journal of Medical Association of Malawi · 2025Article
- Overdose prevention centres as spaces of safety, trust and inclusion: A causal pathway based on a realist review.Drug and alcohol review · 2024Review
- To test or to not test: A retrospective cross-sectional study on potentially inappropriate use of pathology testing in South Australian hospitals.American journal of clinical pathology · 2024Article
- Article
- Article
- Article
- The teaching and learning of communication skills for social work students: a realist synthesis protocol.Systematic reviews · 2022Article
- Article
- Understanding maternity waiting home uptake and scale-up within low-income and middle-income countries: a programme theory from a realist review and synthesis.BMJ global health · 2022Review
- Understanding the use of the National Early Warning Score 2 in acute care settings: a realist review protocol.BMJ open · 2022Article
- Establishing best practices in cancer online support groups: protocol for a realist review.BMJ open · 2021Article
- A rapid realist review of patient engagement in patient-oriented research and health care system impacts: part one.Research involvement and engagement · 2021Review
- Are communities of practice a way to support health literacy: a study protocol for a realist review.BMJ open · 2021Article
- Article
- Efficiency over thoroughness in laboratory testing decision making in primary care: findings from a realist review.BJGP open · 2021Article
- What methods are being used to create an evidence base on the use of laboratory tests to monitor long-term conditions in primary care? A scoping review.Family practice · 2020Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
2 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionStudies have demonstrated the existence of significant variation in test-ordering patterns in both primary and secondary care, for a wide variety of tests and across many health systems. Inconsistent practice could be explained by differing degrees of underuse and overuse of tests for diagnosis or monitoring. Underuse of appropriate tests may result in delayed or missed diagnoses; overuse may be an early step that can trigger a cascade of unnecessary intervention, as well as being a source of harm in itself. METHODS AND ANALYSIS: This realist review will seek to improve our understanding of how and why variation in laboratory test ordering comes about. A realist review is a theory-driven systematic review informed by a realist philosophy of science, seeking to produce useful theory that explains observed outcomes, in terms of relationships between important contexts and generative mechanisms.An initial explanatory theory will be developed in consultation with a stakeholder group and this 'programme theory' will be tested and refined against available secondary evidence, gathered via an iterative and purposive search process. This data will be analysed and synthesised according to realist principles, to produce a refined 'programme theory', explaining the contexts in which primary care doctors fail to order 'necessary' tests and/or order 'unnecessary' tests, and the mechanisms underlying these decisions. ETHICS AND DISSEMINATION: Ethical approval is not required for this review. A complete and transparent report will be produced in line with the RAMESES standards. The theory developed will be used to inform recommendations for the development of interventions designed to minimise 'inappropriate' testing. Our dissemination strategy will be informed by our stakeholders. A variety of outputs will be tailored to ensure relevance to policy-makers, primary care and pathology practitioners, and patients. PROSPERO REGISTRATION NUMBER: CRD42018091986.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.