Evidence map›Paper›PMID 30567539›Full record

ArticleBMC medicine2018

Practice variation in the use of tests in UK primary care: a retrospective analysis of 16 million tests performed over 3.3 million patient years in 2015/16.

Jack W O'Sullivan, Sarah Stevens, Jason Oke, F D Richard Hobbs, Chris Salisbury, Paul Little, Ben Goldacre, Clare Bankhead, Jeffrey K Aronson, Carl Heneghan and 1 more

Abstract read
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In one paragraph

Article in BMC medicine, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 21 papers.

0numbers the graph read from it
0cells of the map it votes in
21citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

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.

2 · The registry

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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

21 citing papers in PubMed.

  1. Article
  2. Article
  3. Article
  4. Article
  5. Evidence-based tests to monitor adults with type 2 diabetes mellitus in primary care: rapid reviews and consensus process.The British journal of general practice : the journal of the Royal College of General Practitioners · 2025
    Review
  6. Article
  7. Article
  8. Article
  9. Observational
  10. Article
  11. Exploration of reasons for primary care testing (the Why Test study): a UK-wide audit using the Primary care Academic CollaboraTive.The British journal of general practice : the journal of the Royal College of General Practitioners · 2024
    Article
  12. Article
  13. Article
  14. Article
  15. Article
  16. Article
  17. Article
  18. Article
  19. Article
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

Jack W O'SullivanCentre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Oxford, OX2 6GG, UK. jack.osullivan@phc.ox.ac.uk.ORCID 0000-0003-3629-2546
Sarah StevensNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK.
Jason OkeNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK.
F D Richard HobbsNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK.
Chris SalisburyCentre for Academic Primary Care, Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2PS, UK.
Paul LittlePrimary Care and Population Sciences, University of Southampton, Southampton, SO17 1BJ, UK.
Ben GoldacreCentre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Oxford, OX2 6GG, UK.
Clare BankheadCentre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Oxford, OX2 6GG, UK.
Jeffrey K AronsonCentre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Oxford, OX2 6GG, UK.
Carl HeneghanCentre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Oxford, OX2 6GG, UK.
Rafael PereraCentre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Oxford, OX2 6GG, UK.

Funding

Department of Health IS-SPC-0514-10043Wellcome Trust
6 · The paper itself

Abstract

backgroundThe UK's National Health Service (NHS) is currently subject to unprecedented financial strain. The identification of unnecessary healthcare resource use has been suggested to reduce spending. However, there is little very research quantifying wasteful test use, despite the £3 billion annual expenditure. Geographical variation has been suggested as one metric in which to quantify inappropriate use. We set out to identify tests ordered from UK primary care that are subject to the greatest between-practice variation in their use.

methodsWe used data from 444 general practices within the Clinical Practice Research Datalink to calculate a coefficient of variation (CoV) for the ordering of 44 specific tests from UK general practices. The coefficient of variation was calculated after adjusting for differences between practice populations. We also determined the tests that had both a higher-than-average CoV and a higher-than-average rate of use.

resultsIn total, 16,496,218 tests were ordered for 4,078,091 patients over 3,311,050 person-years from April 1, 2015, to March 31, 2016. The tests subject to the greatest variation were drug monitoring 158% (95%CI 153 to 163%), urine microalbumin (52% (95%CI 49.9 to 53.2%)), pelvic CT (51% (95%CI 50 to 53%)) and Pap smear (49% (95%CI 48 to 51%). Seven tests were classified as high variability and high rate (clotting, vitamin D, urine albumin, prostate-specific antigen (PSA), bone profile, urine MCS and C-reactive protein (CRP)).

conclusionsThere are wide variations in the use of common tests, which is unlikely to be explained by clinical indications. Since £3 billion annually are spent on tests, this represents considerable variation in the use of resources and inefficient management in the NHS. Our results can be of value to policy makers, researchers, patients and clinicians as the NHS strives towards identifying overuse and underuse of tests.

Indexed as

Practice Patterns, Physicians'Primary Health CareAdultDiagnostic Tests, RoutineFemaleHealth PolicyHumansMaleMiddle AgedNational Health ProgramsRetrospective StudiesUnited KingdomGeneral practiceHealth policyImagingOverusePrimary careTest use

Identifiers

PMID30567539
PMCPMC6300913

What OpenQuestion holds

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Registered trials

None linked

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.