Diagnostic Testing for Children in Primary Care

The National Health Service continues to spend at a rate that will be difficult to maintain in the coming years. A big focus of health policymakers is to identify what can be done to drive down costs and improve the efficiency of health care delivery. Ninety percent of health care contact in the UK occurs in general practice, and consultations for children make up one tenth of the general practice workload. Diagnosing medical conditions in children can be difficult. Diagnostic tests, such as blood tests or x-rays, can be used to help general practitioners (GPs) in this process, and a GP may miss a serious diagnosis if a child does not receive the test they need. On the other hand, if a child receives a test they do not need, they may experience unnecessary pain and/or anxiety and it may lead to a cascade of further unnecessary testing and treatments that cause more harm than benefit. 

This project will consist of two work packages. First, we will use data from the Clinical Practice Research Datalink which contains patient and practice-level anonymised data for 60 million patients in the UK, to examine how testing in children has changed over time and explore differences in test use between general practices. This will identify tests that are used more frequently in some practices and less in others. Possible reasons for these differences will be explored, including the child’s level of social and financial disadvantage, whether they have other medical conditions, and how many children have the disease related to the test. Second, we will carry out qualitative interviews with practising GPs in the Thames Valley and South Midlands to explore their views on why there are significant differences in test use for children and what factors they consider when deciding to request a test for a child. If there are tests that have large differences in their use with no identified explanation, then these may represent wasteful or unnecessary testing. It is important to understand why these differences exist to identify areas where further research and intervention is needed.

These results will support the need to update testing guidance for GPs in order to prevent harms to children. Reducing unnecessary testing will also cut down spending and the efficiency of the health system. We will work with parent representatives to make sure the outcomes we report in blogs, academic journal articles, conferences and meetings are important to patients, families, researchers, GPs and policy makers.

Amount Awarded: £23,085