Use of tests in UK primary care

Both overuse and underuse of healthcare are now seen as markers of an ineffective and iniquitous healthcare system.1 International initiatives such as Right Care in the United Kingdom (www.england.nhs.uk/rightcare/) and Choosing Wisely in the United States (www.choosingwisely.org/) have been developed to reduce unwarranted variation and improve patient care.

It is timely then that in this issue O’Sullivan and colleagues (doi:10.1136/bmj.k4666) investigate temporal trends in the use of tests in UK primary care over a 15 year period (2000-15).2 Test use is an integral part of clinical decision making and this large scale study examined more than 260 million tests for more than 11 million patients in primary care. Age and sex adjusted use of tests increased by 8.5% annually (95% confidence interval 7.6% to 9.4%); from 14 869 tests per 10 000 person years in 2000/1 to 49 267 in 2015/16, a 3.3-fold increase. Patients in 2015/16 had on average five tests per year, compared with 1.5 in 2000/1. Test use increased statistically significantly across all age groups, in both sexes, for all test types, and …