A-184 Evidence-based Test Utilization: Test Ordering Patterns in Functional Medicine and Community Clinics, and Implications for Laboratory Stewardship
Authors: Ezra S , Lewis C W , Sadrzadeh S 
Published: October 2024

Abstract

Background
Functional Medicine Physicians (FMPs) use a holistic approach to identify and address “the root cause of a disease”. These physicians routinely order laboratory tests that are not supported by clinical suspicion and practice guidelines (i.e., Centers for Disease Control and Prevention Laboratory Medicine Best Practices, and local diagnostic algorithms) and are unnecessarily duplicative, with inappropriate testing patterns. Ordering unnecessary tests does not improve diagnosis; indeed, 5% of disease-free patients falsely test positive for a given diagnostic test. Test overutilization increases the rate of false positives, leading to unnecessary medical follow-ups, compromised patient care, and financial constraints on the healthcare system. The objective of this study is to: 1) Compare test ordering patterns between FMPs and General Practitioners (GPs) to identify disparities and opportunities for laboratory stewardship improvements. 2) Analyze the potential factors impacting test utilization in areas served by FMPs, 3) investigate the proper approach to improve test utilization.

Methods
Using our laboratory’s information system, we conducted a retrospective study spanning from January 2022 to December 2022 to assess testing patterns by 15 FMPs in Southern Alberta, comparing them to those of randomly selected community GPs within the same geographical region. A query was executed to retrieve data on the top 50 chemistry tests ordered by functional medicine clinics and community clinics. These tests were further categorized into six groups: general chemistry, endocrinology, immunology, trace elements, toxic metals, and vitamins. Data analysis included determining the geographical locations of functional medicine clinics and assessing the socioeconomic status of their patient populations. Additionally, the percentage of abnormal test results were calculated for both functional medicine clinic and community clinics. Furthermore, the average cost of tests per patient, per physician, and per clinic was computed to evaluate the financial implications of testing practices.

Results
Our preliminary results showed significant variability in test ordering practices among FMPs, with potential implications for patient care and healthcare costs. Most tests ordered by FMPs were normal (94%), suggesting a need for further scrutiny regarding the necessity and appropriateness of these tests. A notable trend observed was the disproportionate preference of FMPs for expensive tests, including hormones, vitamins, and toxic metals. Our analysis reveals that the cost per reportable test from FMPs was four times higher compared to the tests ordered by GPs. Furthermore, on average, functional medicine clinics in urban areas ordered around 60% more tests annually compared to their rural counterparts.

Conclusions
Our preliminary findings clearly show a need to monitor the testing behavior more carefully by the functional medicine clinics. The data from this study will be shared with the physicians practicing functional medicine in Alberta. Strategies to improve the test utilization and patient care include educating the functional medicine doctors and provincial healthcare authorities about the appropriate test utilization and the impact of inappropriate use of lab on patient care. In addition, using algorithms for test ordering will be used if the pattern of inappropriate testing continues.