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Research ArticleOriginal Research

Primary Care Physicians' Challenges in Ordering Clinical Laboratory Tests and Interpreting Results

John Hickner, Pamela J. Thompson, Tom Wilkinson, Paul Epner, Megan Shaheen, Anne M. Pollock, Jim Lee, Christopher C. Duke, Brian R. Jackson and Julie R. Taylor
The Journal of the American Board of Family Medicine March 2014, 27 (2) 268-274; DOI: https://doi.org/10.3122/jabfm.2014.02.130104
John Hickner
From the Department of Family Medicine, University of Illinois College of Medicine, Chicago (JH); the Centers for Disease Control and Prevention, Atlanta, GA (PJT, AMP, JRT); the Altarum Institute, Ann Arbor, MI (TW, MS, JL, CCD); Paul Epner LLC, Evanston, IL (PE); and the Department of Pathology, University of Utah, Salt Lake City (BRJ); and ARUP Laboratories, Salt Lake City, UT (BRJ).
MD, MSc
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Pamela J. Thompson
From the Department of Family Medicine, University of Illinois College of Medicine, Chicago (JH); the Centers for Disease Control and Prevention, Atlanta, GA (PJT, AMP, JRT); the Altarum Institute, Ann Arbor, MI (TW, MS, JL, CCD); Paul Epner LLC, Evanston, IL (PE); and the Department of Pathology, University of Utah, Salt Lake City (BRJ); and ARUP Laboratories, Salt Lake City, UT (BRJ).
MS
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Tom Wilkinson
From the Department of Family Medicine, University of Illinois College of Medicine, Chicago (JH); the Centers for Disease Control and Prevention, Atlanta, GA (PJT, AMP, JRT); the Altarum Institute, Ann Arbor, MI (TW, MS, JL, CCD); Paul Epner LLC, Evanston, IL (PE); and the Department of Pathology, University of Utah, Salt Lake City (BRJ); and ARUP Laboratories, Salt Lake City, UT (BRJ).
MPH
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Paul Epner
From the Department of Family Medicine, University of Illinois College of Medicine, Chicago (JH); the Centers for Disease Control and Prevention, Atlanta, GA (PJT, AMP, JRT); the Altarum Institute, Ann Arbor, MI (TW, MS, JL, CCD); Paul Epner LLC, Evanston, IL (PE); and the Department of Pathology, University of Utah, Salt Lake City (BRJ); and ARUP Laboratories, Salt Lake City, UT (BRJ).
MBA, MEd
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Megan Shaheen
From the Department of Family Medicine, University of Illinois College of Medicine, Chicago (JH); the Centers for Disease Control and Prevention, Atlanta, GA (PJT, AMP, JRT); the Altarum Institute, Ann Arbor, MI (TW, MS, JL, CCD); Paul Epner LLC, Evanston, IL (PE); and the Department of Pathology, University of Utah, Salt Lake City (BRJ); and ARUP Laboratories, Salt Lake City, UT (BRJ).
MPH
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Anne M. Pollock
From the Department of Family Medicine, University of Illinois College of Medicine, Chicago (JH); the Centers for Disease Control and Prevention, Atlanta, GA (PJT, AMP, JRT); the Altarum Institute, Ann Arbor, MI (TW, MS, JL, CCD); Paul Epner LLC, Evanston, IL (PE); and the Department of Pathology, University of Utah, Salt Lake City (BRJ); and ARUP Laboratories, Salt Lake City, UT (BRJ).
BA
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Jim Lee
From the Department of Family Medicine, University of Illinois College of Medicine, Chicago (JH); the Centers for Disease Control and Prevention, Atlanta, GA (PJT, AMP, JRT); the Altarum Institute, Ann Arbor, MI (TW, MS, JL, CCD); Paul Epner LLC, Evanston, IL (PE); and the Department of Pathology, University of Utah, Salt Lake City (BRJ); and ARUP Laboratories, Salt Lake City, UT (BRJ).
MS
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Christopher C. Duke
From the Department of Family Medicine, University of Illinois College of Medicine, Chicago (JH); the Centers for Disease Control and Prevention, Atlanta, GA (PJT, AMP, JRT); the Altarum Institute, Ann Arbor, MI (TW, MS, JL, CCD); Paul Epner LLC, Evanston, IL (PE); and the Department of Pathology, University of Utah, Salt Lake City (BRJ); and ARUP Laboratories, Salt Lake City, UT (BRJ).
PhD
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Brian R. Jackson
From the Department of Family Medicine, University of Illinois College of Medicine, Chicago (JH); the Centers for Disease Control and Prevention, Atlanta, GA (PJT, AMP, JRT); the Altarum Institute, Ann Arbor, MI (TW, MS, JL, CCD); Paul Epner LLC, Evanston, IL (PE); and the Department of Pathology, University of Utah, Salt Lake City (BRJ); and ARUP Laboratories, Salt Lake City, UT (BRJ).
MD, MS
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Julie R. Taylor
From the Department of Family Medicine, University of Illinois College of Medicine, Chicago (JH); the Centers for Disease Control and Prevention, Atlanta, GA (PJT, AMP, JRT); the Altarum Institute, Ann Arbor, MI (TW, MS, JL, CCD); Paul Epner LLC, Evanston, IL (PE); and the Department of Pathology, University of Utah, Salt Lake City (BRJ); and ARUP Laboratories, Salt Lake City, UT (BRJ).
PhD, MS
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  • Article
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Article Figures & Data

Figures

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  • Figure 1.
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    Figure 1.

    Overcoming uncertainty in ordering laboratory diagnostic tests. The percentages of primary care physicians reporting the helpfulness of these tactics as very helpful or extremely helpful and the percentages using these tactics daily or at least once a week are shown. PCP, primary care physician.

  • Figure 2.
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    Figure 2.

    Overcoming uncertainty in interpreting laboratory test results. The percentages of primary care physicians reporting the usefulness of these tactics as very useful or extremely useful and the percentages using these tactics daily or at least once a week are shown. PCP, primary care physician.

  • Figure 3.
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    Figure 3.

    Solutions for more effective use of diagnostic laboratory testing. The percentages of primary care physicians endorsing these solutions as very useful or extremely useful and the percentage with these solutions available at their site. CPOE, computerized physician order entry.

Tables

  • Figures
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    Table 1. Characteristics of Respondents*
    CharacteristicsRespondents
    Medical specialty†
        Internal medicine565 (45.5)
        Family practice648 (52.1)
        Other84 (6.8)
    Sex
        Male756 (62.1)
        Female461 (37.9)
    Practice ownership
        Physician or group of physicians558 (45.1)
        Hospital240 (19.4)
        Healthcare organization larger than 1 hospital190 (15.4)
        Academic institution129 (10.4)
        Other119 (9.6)
    Mean age, years (range)53.0 (27–83)
    Mean years in practice (range)20.8 (1–56)
    • Data are n (%) unless otherwise indicated.

    • ↵* Not all respondents answered each question.

    • ↵† Respondents could select all that apply.

    • View popup
    Table 2. Challenges Reported by Primary Care Physician Respondents When Ordering Laboratory Diagnostic Tests and Using Test Results
    ChallengesRespondents Reporting Factor is Very or Extremely Problematic (%)
    Ordering diagnostic tests
        Cost factors
            Patient costs55
            Insurance policies limit testing48
            Insurance policies mandate use of a specific lab40
            Lack of comparative cost information39
        Ordering mechanisms
            Different test names20
            Tests not available except in a panel20
            Different tests in test panels18
    Using diagnostic tests
        Receiving results
            Results not received in a timely manner34
            Previous results are not easily available32
            Errors in results are suspected25
            Results are inconsistent with patient's symptoms24
        Report format
            Lab-to-lab variation in normal range22
            Lab-to-lab variation in report formats21
            Lab report format is difficult to understand18
            Not enough information in lab report16
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The Journal of the American Board of Family     Medicine: 27 (2)
The Journal of the American Board of Family Medicine
Vol. 27, Issue 2
March-April 2014
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Primary Care Physicians' Challenges in Ordering Clinical Laboratory Tests and Interpreting Results
John Hickner, Pamela J. Thompson, Tom Wilkinson, Paul Epner, Megan Shaheen, Anne M. Pollock, Jim Lee, Christopher C. Duke, Brian R. Jackson, Julie R. Taylor
The Journal of the American Board of Family Medicine Mar 2014, 27 (2) 268-274; DOI: 10.3122/jabfm.2014.02.130104

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Primary Care Physicians' Challenges in Ordering Clinical Laboratory Tests and Interpreting Results
John Hickner, Pamela J. Thompson, Tom Wilkinson, Paul Epner, Megan Shaheen, Anne M. Pollock, Jim Lee, Christopher C. Duke, Brian R. Jackson, Julie R. Taylor
The Journal of the American Board of Family Medicine Mar 2014, 27 (2) 268-274; DOI: 10.3122/jabfm.2014.02.130104
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Keywords

  • Diagnostic Services
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  • Primary Health Care

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