Het opvolgen van adviezen voor bloedonderzoek door huisartsen bij gebruik van een op de NHG-standaarden gebaseerde elektronische aanvraagmodule (BloedLink)

To determine the compliance of Dutch general practitioners with the recommendations for blood test ordering as defined in the guidelines of the Dutch College of General Practitioners (NHG).

Design

Prospective, observational.

Method

A guideline-based decision support system for blood test ordering, BloedLink, was integrated into the electronic patient records of 31 general practitioners, practising in 23 practices (16 solo). Guideline compliance was then assessed over a 12-month period (1 March 1996-28 February 1997) by comparing the recommendations for test ordering with the actually ordered test(s). Compliance was expressed as the percentage of order forms per practice and per indication that followed the recommendations for test ordering in the NHG standards. The most frequently added tests in the non-compliant order forms were compared with the revisions in the guidelines in the period March 1997 through October 1999.

Results

Of the 12,668 order forms submitted to the laboratory, 9091 (71) had been created with the aid of BloedLink instead of the usual paper form. Twelve indications accounted for 80.2 of the 7346 order forms in which an indication present in BloedLink had been used. The most frequently used indication for test ordering was ‘vague complaints’ (2209 order forms; 30.1). Of the 7346 order forms, 39 were compliant. The most frequent cause for non-compliance was the addition of tests. Six of the 12 tests most frequently added to the order forms were supported by the recommendations for blood tests in the revised guidelines.

Conclusion

In general practice, non-compliance with the guidelines is caused predominantly by the addition of extra tests. Non-compliance with a guideline seems to be caused partly by practitioners applying new medical insights before they are incorporated into a revision of that guideline.