THE USE OF BIOCHEMICAL TESTS RELATED TO KIDNEY DISEASE ASSESSMENT BY YOUNG PHYSICIANS: A TRANSVERSAL STUDY

AUTHORS: Rodrigo Bueno de Oliveira, Anna Beatriz de Araújo, Marcos Vinicius de Sousa, Marilia Paiva Martins,

KEYWORD: kidney disease; laboratory test; health education; public health.

ABSTRACT

INTRODUCTION: Unnecessary complementary exams during hospital stays have a detrimental impact on patient care and add significant costs to the healthcare system. The study hypothesis is that unnecessary laboratory testing frequency may be high among young physicians, especially those related to kidney diseases. Accordingly, low usefulness may be present. To test this hypothesis, our study aimed to evaluate the frequency and usefulness of complementary exams requested by young physicians, with a primary endpoint of identifying potential areas for improvement in ordering these exams. Additionally, we sought to assess the knowledge of young physicians regarding the financial aspects of medical practice and the impact of their practices on the sustainability of healthcare.

METHODSANDMATERIALS: This is a transversal study conducted at a public university hospital in Campinas, Brazil. Researchers collected clinical and laboratory data from inpatients admitted to the Internal Medicine ward between Aug/2021 and Feb/2022. Serum and urinary laboratory tests related and unrelated to kidney disease assessment were analyzed according to their results, clinical usefulness accuracy, and reference range of the local laboratory. The researchers also collected demographic and clinical data, including comorbidities, and adverse events associated with laboratory testing, such as blood transfusion and phlebitis. Cases of incomplete medical data were excluded. The study participants were selected randomly and according to the researcher's convenience. Young physicians answered a structured questionnaire (18 different questions) about health-financial knowledge aspects.

RESULTS AND DISCUSSION: 30 patients were included, 53% male, with a mean age of 61 ± 13 years. During 193 days of hospital stay, 790 laboratory exams were registered, including 754 serum and 36 urinary tests. The frequency of unnecessary tests related to kidney disease was significantly higher than those unrelated to this class of diseases (n = 284, 58% vs. n = 134, 45%, respectively, p < 0.05). Serum creatinine and urea were the most kidney disease-related tests ordered, being over half of them unnecessary (65% and 53%, respectively). Eighty-one (12%) of young physicians answered the questionnaire. Most (n = 70, 86%) declared that they had not received health-financial education during graduation, although 95% agreed it could impact test requisition decisions. The frequency of unnecessary tests associated with young physicians ordering was high, especially those related to kidney disease assessment. The resident physicians related poor health-financial education during graduation. The impact of educational initiatives to avoid unnecessary testing should be tested in future studies.

REFERENCES: 1. 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 Dec 1;82(974):823–9. 2. Schroeder SA, Myers LP, McPhee SJ, Showstack JA, Simborg DW, Chapman SA, et al. The failure of physician education as a cost containment strategy. Report of a prospective controlled trial at a university hospital. JAMA. 1984 Jul 13;252(2):225–30. 3. Spiegel JS, Shapiro MF, Berman B, Greenfield S. Changing physician test ordering in a university hospital. An intervention of physician participation, explicit criteria, and feedback. Arch Intern Med. 1989 Mar;149(3):549–53. 4. Koch C, Roberts K, Petruccelli C, Morgan DJ. The Frequency of Unnecessary Testing in Hospitalized Patients. Am J Med. 2018 May;131(5):500–3.

ACKNOWLEDGMENTS: The research team would like to thank the patients, resident physicians, and the multidisciplinary team involved in the care of patients included in this study.

ETHICAL RESEARCH COMMITTEE (CEP) APPROVAL? Yes


SUBMISSION THEMES: AXIS 4 - Student Engagement and Student Development