Utilisation and trends of laboratory testing and point-of-care testing in primary care in Germany: an analysis of claims data

Abstract

Objectives German general practitioners (GPs) either order laboratory tests from external laboratories (initiated laboratory services (ILS)) or perform point-of-care tests (POCTs) within the GP practice. This study investigated the current use and time trends of laboratory testing in German GP practices with a particular focus on POC testing. Design Retrospective consecutive cross-sectional study by analysis of complete outpatient healthcare claims data (2017-2022). Setting Primary care in Thuringia, a federal state in central Germany. Participants Data from 2061 GPs. Primary and secondary outcome measures Number of performed laboratory analyses per year, mean number of laboratory analyses per patient and year. Results In 2022, 1601 GPs performed 16.1 million laboratory analyses, with 14.9 million (92.5%) being ILS and 1.2 million (7.5%) being POCTs conducted within GP practices. The mean number of laboratory tests per patient was 15.5 in 2022. The number of laboratory tests performed per patient decreased by 18.8% from 2017 to 2022. An especially pronounced reduction was observed in the use of POCTs (-36.0%). During the whole study period, the most common initiated laboratory analyses included creatinine, blood cell count, glucose, thyroid-stimulating hormone and HbA1/HbA1c. The most frequently employed POCTs were glucose, urine test strip, prothrombin time/international normalised ratio, HbA1/HbA1c, erythrocyte sedimentation rate and microalbuminuria. POC testing instead of ILS was more likely performed in older patient groups (≥40 years) compared with young adult patients (18-39 years) (adjusted OR (aOR) 40-59 years: 1.19 (95% CI 1.14 to 1.24); aOR 60-79 years: 1.48 (95% CI 1.40 to 1.57); aOR >79 years: 1.43 (95% CI 1.34 to 1.54)). Conclusions German GPs regularly employ laboratory testing, primarily utilising external laboratory service, while POC testing plays a relatively minor role. The notable decline in the use of POCT testing may be attributed to several factors, including regulations from healthcare authorities, reimbursement guidelines and increasing test costs.