CHAPTER ten
Investigations
96
National Medical Care Statistics 2014
CHAPTER 10: INVESTIGATIONS
Laboratory and other medical investigations are essential for the diagnosis and management of many conditions. In the primary care setting, the tests are generally requested to aid in diagnosis, establish a
baseline before commencing treatment, monitor long-term conditions for disease control, ensure a medication dose is within the therapeutic range, detect adverse effects to treatment and monitor or
predict the response to treatment.
1
While these investigations can help in the management or monitoring of patients, it must also be remembered that the rates at which the investigations are
ordered can directly affect the healthcare expenditure. This chapter reports the investigations ordered by primary care providers at the point of patient encounter, which include all blood and urine
pathological tests, imaging studies and other diagnostic tests.
10.1
N : ;
BER OF INVESTIGATIONS PER ENCO
:
NTER
Table 10.1.1 shows the number of encounters in primary clinics during which at least one investigation was ordered. Of all 325,818 encounters recorded in primary care, 22.6 had investigations ordered. The
higher proportion of investigations in public clinics 39.6 as compared to private 11.1 can be due to the higher proportion of chronic diseases managed in public sector.
Table 10.1.1: Number of encounters with investigations ordered in primary care clinics in 2014
Sector nweighted
count Weighted count
Percent
?
encounters
A B
CI
Overall n
C
325,818 7,272
73,540 22.6 19.7–25.4
Public
n C
D E D F
624 5,945
52,060 39.6 35.4–43.7
Private
n C
D G H F
194 1,327
21,480 11.1 9.6–12.5
The highest numbers of investigations ordered per encounter in public clinics and private clinics were 14 and 18, respectively. Investigations were ordered more frequently in the public clinics, with about
one-fifth 18.7 of the encounters had two or more investigations ordered per encounter, compared to only 2.9 in the private sector Figure 10.1.1.
10.2 TYPES OF INVESTIGATIONS ORDERED
Table 10.2.1 shows the distribution of the most common investigations ordered in primary care in decreasing order of frequency. A total of 143,758 investigations were ordered in primary care, at a rate
of 44.1 investigations per 100 encounters and 32.9 investigations per 100 diagnoses. • More than four-fifths 82.0 of all investigations ordered were laboratorypathological tests.
Glucose andor glucose tolerance test constituted one fifth of these investigations. • Imaging studies accounted for 9.3 of the total investigations. Obstetric ultrasound was the most
frequently ordered imaging modality, recorded at 4.0 of all investigations ordered 1.8 per 100 encounters and 1.3 per 100 diagnoses.
≥
97
22.6 39.6
11.1
• •
Figure 10.1.1: Number
I J
investigations ordered per encounter in primary care clinics in 2014
Table 10.2.1: Types
I J
investigations by ICPC-2 process codes in primary care clinics in 2014
Investigations
K
nweighted count
Weighted count
Percent
L M
investigations n
O P QR S T WX Y
Rate per 100 encounters
95
Z
CI n
O R [ WS X PX Y
Rate per 100 diagnoses
95
Z
CI n
O QR \S
743 Pathology test
12,926 117,
X X ]
X [
36.2 30.5
_
41.9 27.0 23.2
_
30.
X Y
Chemistry 9,210
80,153 55.8
24.6 19.7–29.5 18.4 15.1–21.7
Glucoseglucose tolerance
2,515 24,704
17.2 7.6 5.7–9.4
5.7 4.4–6.9 Electrolytes, urea
creatinine
`
1,805 14,659
10.2 4.5 3.3–5.7
3.4 2.5–4.2 Lipids
1,623 14,503
10.1 4.5 3.5–5.4
3.3 2.6–4.0 Liver function
`
1,191 8,853
6.2 2.7 2.0–3.4
2.0 1.5–2.5 HbA1c
961 8,227
5.7 2.5 1.6–3.4
1.9 1.2–2.5 Chemistry; othe
r `
495 3,883
2.7 1.2 0.8–1.6
0.9 0.6–1.2 Urateuric acid
351 2,372
1.6 0.7 0.4–1.1
0.5 0.3–0.8 Thyroid function
144 1,674
1.2 0.5 0.4–0.7
0.4 0.3–0.5
Nil One
Two Three
≥ Four Public
60.4 20.8
8.2 3.5
7.0 Private
88.9 8.1
1.8 0.4
0.7 10
20 30
40 50
60 70
80 90
100
a b
c d
b g
h i
j b
g d
i k
g h
b c
l m
o p
stu vw x yz
{ |}w ~{ { y |~
w
x w
|y t| w x
98
National Medical Care Statistics 2014
Table 10.2.1 continued: Types
investigations by ICPC-2 process codes in primary care clinics in 2014
Investigations
nweighted count
Weighted count
Percent
investigations n
Rate per 100 encounters
95
CI n
Rate per 100 diagnoses
95
CI n
743
Other NEC 1,395
14,987 10.4
4.6 4.0–5.2 3.4 3.0–3.9
Urine tes
900 9,504
6.6 2.9 2.4–3.4
2.2 1.8–2.6 Blood test
274 2,920
2.0 0.9 0.6–1.2
0.7 0.4–0.9 Urine pregnancy
test 107
1,698 1.2
0.5 0.3–0.8 0.4 0.2–0.6
Haematology 1,534
14,890 10.4
4.6 3.7–5.5 3.3 3.2–3.3
Full blood count 1,216
11,636 8.1
3.6 2.8–4.4 2.7 2.1–3.2
Blood; other
121 941
0.7 0.3 0.2–0.4
0.2 0.1–0.3 Haemoglobin
70 702
0.5 0.2 0.1–0.3
0.2 0.1–0.3 Microbiology
716 7,143
5.0 2.2 1.5–2.8
1.6 1.2–2.1 Hepatitis serology
183 1,932
1.3 0.6 0.3–0.9
0.4 0.2–0.7 Tuberculosi
203 1,761
1.2 0.5 0.3–0.8
0.4 0.2–0.6 H
129 1,187
0.8 0.4 0.2–0.5
0.3 0.2–0.4
enereal disease 99
1,106 0.8
0.3 0.2–0.5 0.3 0.1–0.4
Imaging 1,
13,427 9.3
4.1 3.3
4.9 3.1 2.5
3.7
Ultrasound 746
7,226 5.0
2.2 1.7–2.7 1.7 1.3–2.1
Obstetric ultrasound
612 5,715
4.0 1.8 1.3–2.2
1.3 0.9–1.7 Diagnostic radiology
533 6,097
4.2 1.9 1.2–2.6
1.4 0.9–1.9 Che
-ray 349
4,040 2.8
1.2 0.7–1.8 0.9 0.5–1.3
Other investigation 1,
11,070 7.7
3.4 2.3
4.5 2.5 1.
3.3
Physical function test 454
4,552 3.2
1.4 0.7–2.1 1.0 0.6–1.5
Blood pressure
287 3,167
2.2 1.0 0.4–1.6
0.7 0.3–1.2
ision 101
854 0.6
0.3 0.1–0.4 0.2 0.1–0.3
Electrical tracing 538
4,179 2.9
1.3 0.9–1.7 1.0 0.7–1.3
Electrocardiogram 536
4,113 2.9
1.3 0.8–1.7 0.9 0.6–1.2
Diagnostic procedure 294
2,339 1.6
0.7 0.4–1.0 0.5 0.3–0.7
Other diagnostic procedure; NEC
190 1,578
1.1 0.5 0.3–0.7
0.4 0.2–0.5
Medical exam
1,372 1.0
0.4 0.2
0.6 0.3 0.2
0.5
Medical examinationhealth
evaluation completepartial
128 1,372
1.0 0.4 0.2–0.6
0.3 0.2–0.5
Total 15,627
143,
100.0 44.1 37.4
50.
32.9
5
37.3
Comprise multiple ICPC-2 codes see Appendix 4 Note: NEC – Not elsewhere classified.
• •
•
•
99
100
987 4.6
3.4 504
2.9 2.2
920 0.9
0.7 698
0.5 0.4
890 4.6
3.3 636
3.6 2.7
941 0.3
0.2 702
0.2 0.2
143 2.2
1.6 ogy
932 0.6
0.4 761
0.5 0.4
187 0.4
0.3 106
0.3 0.3
427 4.1
3.1
226 2.2
1.7 715
1.8 1.3
y 097
1.9 1.4
040 1.2
0.9
070 3.4
2.5
st 552
1.4 1.0
167 1.0
0.7 854
0.3 0.2
179 1.3
1.0 m
113 1.3
0.9 re
339 0.7
0.5 c
578 0.5
0.4
372 0.4
0.3
44.1 32.9
3
Chapter 10 : Investigations
10.3 MOST FREQ
ENTLY ORDERED INVESTIGATIONS IN P
BLIC AND PRIVATE CLINICS
The ordering rate of investigations differed significantly between the public and private sectors. Nonetheless, the two sectors shared six of the investigations listed among their top 10 list of
investigations ordered Figure 10.3.1 and Figure 10.3.2.
Public clinics
• The most frequently ordered test in the public sector was glucose andor glucose tolerance test 15.1 per 100 encounters.
• Electrolytes, urea and creatinine test, ordered at a rate of 10.1 tests per 100 encounters, was the second most frequently ordered test, followed by lipid profile test 8.4 per 100 encounters.
Private clinics
• Generally, the ordering rates of investigations were much lower for the private sector. Glucose andor glucose tolerance test, the most frequently ordered test in the private sector, was ordered
only at the same rate as the tenth most frequently ordered investigation in the public sector 2.5 tests per 100 encounters.
• Urine test 2.0 per 100 encounters and lipid profile test 1.8 per 100 encounters were the second and third most frequently ordered tests in private clinics, respectively.
Figure 10.3.1: Top 10 investigations ordered in public clinics in 2014
Comprise multiple ICPC-2 codes see Appendix 4
2.5 2.7
3.2 4.3
5.5 6.1
7.0
¡ ¢£
10.1 15.1
2 4
6 8
10 12
14 16
18 20
22
¤¥¦§¨ © ª«¬
® ª¥¦« ¯
Electrocardiogram Obstetric ultrasound
° «¨
± ¦
ª¦ © ª ¯
HbA1c
² ¨ ³¦«
´µ ±
¶ª¨ ® ±
¯
Full blood count Lipids
·¸ ¦¶ª« ®
¸ ¬ª¦ ©
¹ µ«¦
º »
¶«¦ º
ª¨ ±
¨ ±
¦ ¯
Glucoseglucose tolerance
Rate per 100 encounters
100
National Medical Care Statistics 2014
Figure 10.3.2: Top 10 investigations ordered in private clinics in 2014
¼
Comprise multiple ICPC-2 codes see Appendix 4
10.4 DIAGNOSES WITH INVESTIGATIONS ORDERED
Table 10.4.1 reports the most common diagnoses for which investigations were ordered in primary care in 2014.
• The top 10 diagnoses for which investigations were most frequently ordered accounted for 73.2 of all diagnoses accompanied by tests.
• Diabetes accounted for a quarter 24.3 of the diagnoses with at least one investigation ordered. This corresponds with another finding in NMCS 2014 that glucose andor glucose tolerance test
was the most frequently ordered investigation in primary care see Section 10.2. • The second most common diagnosis for which investigations were ordered was hypertension, which
amounted to 16.0 of all diagnoses accompanied by tests, followed by lipid disorder at 9.6. • Together, the three aforementioned chronic diseases represented half 49.9 of all diagnoses for
which investigations were ordered, a finding which could be attributed to the high burden of the three metabolic syndrome-related conditions in primary care see Chapter 8.
0.6 0.7
0.7 0.7
½ ¾¿
1.1 1.2
À ¾¿
2.0 2.5
2 4
6 8
10 12
14 16
18 20
22 Hepatitis serology
Urine pregnancy test
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ÑÒ Ã
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Obstetric ultrasound Blood test
Full blood count Lipids
Õ ÆÎ ÏÃ
Å Ã É Å Ð
Glucoseglucose tolerance
Rate per 100 encounters
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