Going beyond audit and feedback: towards behaviour-based interventions to change physician laboratory test ordering behaviour

摘要

Studies indicate there are a variety of contributing factors affecting physiciantest ordering behaviour. Identifying these behaviours allows development ofbehaviour-based interventions.Methods Through a pilot study, the list of contributing factors in laboratorytests ordering, and the most ordered tests, were identi ed, and given to 50medical students, interns, residents and paediatricians in questionnaire form. The resultsshowed routine tests and peer or supervisor pressure as the most in uential factors affectingphysician ordering behaviour. An audit and feedback mechanism was selected as an appropriateintervention to improve physician ordering behaviour. The intervention was carried out at twointervals over a three-month period.Findings There was a large reduction in the number of laboratory tests ordered; from 908before intervention to 389 and 361 after rst and second intervention, respectively. There wasa signi cant relationship between audit and feedback and the meaningful reduction of 7 outof 15 laboratory tests including complete blood count (p = 0.002), erythrocyte sedimentationrate (p = 0.01), C-reactive protein (p = 0.01), venous blood gas (p = 0.016), urine analysis (p= 0.005), blood culture (p = 0.045) and stool examination (p = 0.001).Conclusion The audit and feedback intervention, even in short duration, affects physicianordering behaviour. It should be designed in terms of behaviour-based intervention anddiagnosis of the contributing factors in physicians’ behaviour. Further studies are required tosubstantiate the effectiveness of such behaviour-based intervention strategies in changingphysician behaviour.