İlker AKARKEN, Nergiz ZORBOZAN, Gökçe Filiz ATİKELER

Gereksiz serbest PSA test istemleri ve önleyici faaliyetlerin etkinliğinin değerlendirilmesi

Amaç: Çalışmamızın amacı, Prostat Kanseri Avrupa Üroloji Derneği - Avrupa Teropotik Radyoloji ve Onkoloji Derneği - Uluslararası Geriatrik Onkoloji Derneği kılavuzuna (EAPS-ESTRO-SIOG) kılavuzuna göre gereksiz istenen fPSA testlerini belirlemek ve gereksiz test istemleri için yaptığımız önleyici faaliyetlerin etkinliğini değerlendirmektir. Gereç Yöntem: EAPS-ESTRO-SIOG kılavuzuna gore tPSA seviyesi >10 veya <4 ng/mL olan hastalarda fPSA/tPSA oranının kullanımı klinik olarak önemsiz kabul edilmektedir. Laboratuvarımızda tPSA için ölçüm belirsizliği ±% 15,49 olarak hesaplandı. Belirsizlik değerine göre sınır değerler (4 ve 10 ng / mL) genişletildi. tPSA düzeyi <3,38 ve> 11,54 ng/mL olan hastalarda yapılan fPSA test istemleri gereksiz istem kabul edildi. Daha önce başka bir laboratuvarda tPSA testi çalışılmamış hastalarda tPSA testi olmadan yapılan fPSA test istemleri gereksiz olarak değerlendirildi. Hastane bilgi sistemine fPSA test istemi ile ilgili rehber önerilerini içeren bilgilendirme mesajı eklendi. Bilgi mesajı eklemeden önceki ve sonraki 6 aylık dönemde istenen gereksiz fPSA testleri değerlendirildi. Bulgular: Bilgi mesajı eklendikten sonraki 6 aylık dönemde gereksiz istenen fPSA test sayısı anlamlı olarak azaldı(p <0.05). Bilgilendirme mesajının eklenmesinden sonraki 6 aylık dönemde tPSA test istemi olmadan fPSA test istemi yapılmadı. Sonuç: Test istemleri yapılırken kılavuzda belirtilen kuralların ve algoritmaların kullanılması oldukça önemlidir. Çalışmamızın sonuçları hastane bilgi sistemine kılavuz önerilerine göre bilgilendirme mesajı eklenmesinin gereksiz test istemlerini azaltabileceğini göstermektedir.

Anahtar Kelimeler:

Gereksiz testler;, serbest PSA;, laboratuvar maliyetleri;, preanalitik faz;

Unnecessary free PSA test requests and assessment of the effectiveness of preventive activities

Objective: The aim of our work is to determine unnecessary fPSA test requests according to the European Association of Urology, European Society for Radiotherapy & Oncology guideline (EAPS-ESTRO-SIOG) and to assess the effectiveness of preventive actions we have made due to unnecessary test order.Methods: According to the guidelines of EAPS-ESTRO-SIOG, the use of fPSA/tPSA ratio is considered clinically insignificant in patients with tPSA >10ng/mL or <4ng/mL. Measurement uncertainty for tPSA was calculated as±15.49% in our laboratory. The limit values(4 and 10 ng/mL)were expanded according to the uncertainty value. fPSA tests ordered in patients with tPSA levels <3.38 and >11.54 ng/mL were considered unnecessary. In addition, if the patient did not have a tPSA test previously performed in another laboratory, the requested fPSA tests in patients without tPSA test in our laboratory was evaluated as unnecessary. An informational message has been added to the hospital information system regarding the guideline recommendation for the fPSA. Unnecessary fPSA tests in the six-month term before and after adding the information note were evaluated.Results: The number of unnecessary fPSA test significantly decreased in the six-month term after the addition of information note(p<0.05). The fPSA test was not requested without the tPSA test in 6 month period after the addition of the information note. Conclusion: It is important to use the rules and algorithms mentioned in the guidelines when ordering the test. The results of our study suggest that the addition of an informative message according to the guideline recommendation to the hospital information system can reduce the unnecessary test order.

Keywords:

Unnecessary test;, free PSA;, laboratory costs;, pre-analytical phase;,

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1. Zhi M, Ding EL, Theisen-Toupal J, Whelan J, Arnaout R. The landscape of inappropriate laboratory testing: a 15-year meta-analysis. PLoS One 2013;8:e78962.
2. Oliveira AM, Oliveira MV, Souza CL. Prevalence of unnecessary laboratory tests and related avoidable costs in intensive care unit. J Bras Patol Med Lab 2014;50:410-6.
3. Doll H, Shine B, Kay J, James T, Glasziou P. The rise of cholesterol testing: how much is unnecessary? Br J Gen Pract 2011;61:e81-8.
4. Wu AH. Reducing the inappropriate utilization of clinical laboratory tests. Conn Med 1997;61(1):15-21.
5. Tabriz MS, Riederer K, Baran J Jr, Khatib R. Repeating blood cultures during hospital stay : practice pattern at a teaching hospital and a proposal for guidelines. Clin Microbiol Infect 2004;10(7):624-27.
6. Zaat J, Eijk J Van. General Practitioners’ Uncertainty, Risk Preference, and Use of Laboratory Tests. Medical care 1992;30(9):846-54.
7. Hawkins RC. Potentially Inappropriate Repeat Laboratory Testing in Inpatients. Clin Chem 2006;52(4):784-85.
8. Kwok J, Jones B. Unnecessary repeat requesting of tests: an audit in a government hospital immunology laboratory. J Clin Pathol 2005;58:457-62.
9. Flamm M, Fritsch G, Seer J, Panisch S, Sönnichsen AC. Non-adherence to guidelines for preoperative testing in a secondary care hospital in Austria: the economic impact of unnecessary and double testing. Eur J Anaesthesiol 2011;28:867-3.
10. Bridges SA, Papa L, Norris AE, Chase SK. Duplicated laboratory tests: a hospital audit. Clin Chem 2012;58:1371-2.
11. Iliadi V, Kastanioti C, Maropoulos G, Niakas D. Inappropriately repeated lipid tests in a tertiary hospital in Greece: the magnitude and cost of the phenomenon. Hippokratia 2012;16:261-6.
12. Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer 2015;136(5):E359-86.
13. Ilic D, Neuberger MM, Djulbegovic M, Dahm P. Screening for prostate cancer. Cochrane Database Syst Rev 2013;(1):CD004720.
14. Romero Otero J, Garcia Gomez B, Campos Juanatey F, Touijer KA. Prostate cancer biomarkers: an update. Urol Oncol 2014;32(3):252-60.
15. Catalona, W.J., et al. Use of the percentage of free prostate-specific antigen to enhance differentiation of prostate cancer from benign prostatic disease: a prospective multicenter clinical trial. JAMA 1998;279(19):1542-7.
16. Mottet N., Bellmunt J., Briers E., Bolla M., Bourke L., Cornford P., De Santis M., Henry A., Joniau S., Lam T., Mason M.D., Van den Poel H., Van den Kwast T.H., Rouvière O., Wiegel T.; members of the EAU – ESTRO – ESUR –SIOG Prostate Cancer Guidelines Panel. EAU – ESTRO – ESUR – SIOG Guidelines on Prostate Cancer. Available at: https://uroweb.org/wp-content/uploads/09-Prostate-Cancer_2017_web.pdf Accessed December 25, 2017.
17. S L R Ellison and A Williams (Eds). Eurachem/CITAC guide: Quantifying Uncertainty in Analytical Measurement, Third edition, (2012) ISBN 978-0-948926-30-3. Available from www.eurachem.org.
18. Miyakis S, Karamanof G, Liontos M, Mountokalakis TD. Factors contributing to inappropriate ordering of tests in an academic medical department and the effect of an educational feedback strategy. Postgrad Med J 2006;82:823-9.
19. Gardiner FW. Audit and feedback to reduce inappropriate Full Blood Count pathology testing. Journal of Hospital Administration 2016;5(2):42-46.
20. Kuo NW1, Lin HC, Lee HC. Physician Clinical Experience and Inappropriate ProstateSpecific Antigen Screening: Evidence From an Asian Country. J Urol 2008;180(5):1954-8.
21. Bayram C, Britt H, Miller G, Valenti L. Evidence-practice gap in GP pathology test ordering: a comparison of BEACH pathology data and recommended testing. Final report. Sydney, Aust: University of Sydney, Family Medicine Research Centre; 2009. http://www.health.gov.au/internet/main/publishing.nsf/Content/9C300FE48F876E95CA257BF0001ACE0E/$File/Evidence-practice%20gap%20in%20GP%20pathology%20test%20ordering.pdf. Erişim Tarihi: 09.06.2018.
22. Morgan S, Morgan A, Kerr R, Tapley A, Magin P. Test ordering by GP trainees: Effects of an educational intervention on attitudes and intended practice. Can Fam Physician 2016;62(9):733-41.
23. Ferraro S, Panteghini M. The role of laboratory in ensuring appropriate test requests. Clin Biochem 2017;50(10-11):555-561.
24. Sinitsky L, Brierley J. Reducing the number ofunnecessary liver function tests requested on the. Paediatric Intensive Care Unit. BMJ Quality Improvement. Reports 2017;6:u214071.