Variation in laboratory testing for patients with long-term conditions: longitudinal cohort study in UK primary care

Use of laboratory testing has increased in the UK over the last few decades, with considerable geographical variation.To evaluate what laboratory tests are used to monitor people with hypertension, type 2 diabetes, or chronic kidney disease and assess variation in test use in UK primary care.Longitudinal cohort study of people registered with UK general practices between June 2013 and May 2018 and previously diagnosed with hypertension, type 2 diabetes, or chronic kidney disease (CKD).CPRD primary care data linked to ethnicity and deprivation was used to examine testing rates over time, by GP practice, age, sex, ethnicity, and socioeconomic deprivation, with age-sex standardisation.Nearly 1 million patients were included, and over 27 million tests. The most ordered tests were for renal function (1,463 per 1,000 person-years), liver function (1,063 per 1,00 person-years), and full blood count (996 per 1,000 person-years). There was evidence of under-testing (compared to current guidelines) for HbA1c and ACR/microalbumin, and potential over-testing of lipids, full blood count, liver function, and thyroid function. Some GP practices had up to 27 times higher testing rates than others (HbA1c testing amongst CKD patients).Testing rates are no longer increasing, but they are not always within the guidelines for monitoring long-term conditions. There was considerable variation by GP practice, indicating uncertainty over the most appropriate testing frequencies for different conditions. Standardising the monitoring of long-term conditions based on the latest evidence would provide greater consistency of access to monitoring tests.