Comparative Study of the Physician Specialty and Laboratory Services Requested for Patients with COVID-19: Evidence from a Large Hospital

Document Type : Original Article (s)

Abstract

Background: In order to timely identify and treat the patients with coronavirus disease 2019 (COVID-19), the use of rapid and accurate laboratory diagnostic methods is important, and tests such as erythrocyte sedimentation rate (ESR), complete blood count (CBC), C-reactive protein (CRP), arterial blood gas (ABG), and real time-polymerase chain reaction (RT-PCR) are helpful in assessing patient's condition and diagnosing the disease. This was a comparative study of the physician specialty and laboratory services requested for patients with COVID-19 based on the evidence from a large hospital."
Methods: This was a descriptive-analytical cross-sectional study in Mashhad City, Iran, on 307 patients with COVID-19 hospitalized under the management of internal and infectious therapist groups, selected using random stratified sampling method. Data were entered into SPSS version 22 statistical software.
Results: A statistically significant relationship was reported between the two groups of internal and infectious therapists in the capitation and cost of K, Na, alkaline phosphatase (ALP), aspartate aminotransferase (AST), blood albumin (Alb), bilirubin (Bili), blood sugar (BS), fasting blood sugar (FBS), Ca, Mg, phosphorus (Pho), treponema pallidum immobilization (TPI), CBC, CBC differential (CBC/Diff), and ABG tests, and tracheal tube culture and antibiogram. Patients were discharged with 89.7% recovery and 10.3% death in the first group, and with 95.5% recovery and 4.5% death in the second group.
Conclusion: Different behavioral patterns in prescribing and performing laboratory services by physicians with different specialties, especially in times of epidemic outbreaks, may indicate the lack of national laboratory protocol and also limited access to reliable diagnostic tests, while wasting resources, impose direct and indirect costs to patients and medical centers.

Keywords


Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020; 395(10223): 497-506.
Jiang F, Deng L, Zhang L, Cai Y, Cheung CW, Xia Z. Review of the clinical characteristics of coronavirus disease 2019 (COVID-19). J Gen Intern Med 2020; 35(5): 1545-9.
Yang Y, Yang M, Shen C, Wang F, Yuan J, Li J, et al. Laboratory diagnosis and monitoring the viral shedding of 2019-nCoV infections. medRxiv 2020.
Ai T, Yang Z, Hou H, Zhan C, Chen C, Lv W, et al. Correlation of chest CT and RT-PCR testing for coronavirus disease 2019 (COVID-19) in China: A Report of 1014 cases. Radiology 2020; 296(2): E32-E40.
World Health Organization. Laboratory testing for coronavirus disease (COVID-19) in suspected human cases: Interim guidance, 19 March 2020. Geneva, Switzerland: WHO; 2020.
Aeenparast A, Farzadi F, Maftoon F, Zahirian Moghadam T. Feasibility of estimating cost of diagnostic radiology and sonography services by using activity based costing. Payesh Health Monit 2015; 14(1): 15-23. [In Persian].
Fryer AA, Smellie WS. Managing demand for laboratory tests: A laboratory toolkit. J Clin Pathol 2013; 66(1): 62-72.
Plebani M. Errors in clinical laboratories or errors in laboratory medicine? Clin Chem Lab Med 2006; 44(6): 750-9.
Conner M, Norman P. Predicting health behaviour. 1st ed. New York, NY: McGraw-Hill Education; 2005.
Kiechle FL, Arcenas RC, Rogers LC. Establishing benchmarks and metrics for disruptive technologies, inappropriate and obsolete tests in the clinical laboratory. Clin Chim Acta 2014; 427: 131-6.
Conner M, Sparks P. The theory of planned behaviour and health behaviours. Predicting health behaviour: Research and practice with social cognition models. Maidenhead, BRK, England: Open University Press; 1996. p. 121-62.
Li G, De Clercq E. Therapeutic options for the 2019 novel coronavirus (2019-nCoV). Nat Rev Drug Discov 2020; 19(3): 149-50.
Cheng SW, Wang CY, Ko Y. Costs and length of stay of hospitalizations due to diabetes-related complications. J Diabetes Res 2019; 2019: 2363292.
Sharifzadeh S. How can we enhance the value of laboratory tests? Lab Diag 2020; 11(46): 60-5. [In Persian].
Freeborn DK, Baer D, Greenlick MR, Bailey JW. Determinants of medical care utilization: Physicians' use of laboratory services. Am J Public Health 1972; 62(6): 846-53.
Naugler C, Thomas R, Turin TC, Guo M, Vaska M. Yearly clinical laboratory test expenditures for different medical specialties in a major Canadian city. Am J Clin Pathol 2015; 144(1): 97-102.