Gereksiz serbest PSA test istemleri ve önleyici faaliyetlerin etkinliğinin değerlendirilmesi

Öz

Amaç: Çalışmamızın amacı, Prostat Kanseri Avrupa Üroloji Derneği - Avrupa Teropotik Radyoloji ve Onkoloji Derneği - Uluslararası Geriatrik Onkoloji Derneği kılavuzuna (EAPS-ESTRO-SIOG) kılavuzuna göre gereksiz istenen fPSA testlerini belirlemek ve gereksiz test istemleri için yaptığımız önleyici faaliyetlerin etkinliğini değerlendirmektir.

Gereç Yöntem: EAPS-ESTRO-SIOG kılavuzuna gore tPSA seviyesi >10 veya <4 ng/mL olan hastalarda fPSA/tPSA oranının kullanımı klinik olarak önemsiz kabul edilmektedir. Laboratuvarımızda tPSA için ölçüm belirsizliği ±% 15,49 olarak hesaplandı. Belirsizlik değerine göre sınır değerler (4 ve 10 ng / mL) genişletildi. tPSA düzeyi <3,38 ve> 11,54 ng/mL olan hastalarda yapılan fPSA test istemleri gereksiz istem kabul edildi. Daha önce başka bir laboratuvarda tPSA testi çalışılmamış hastalarda tPSA testi olmadan yapılan fPSA test istemleri gereksiz olarak değerlendirildi. Hastane bilgi sistemine fPSA test istemi ile ilgili rehber önerilerini içeren bilgilendirme mesajı eklendi. Bilgi mesajı eklemeden önceki ve sonraki 6 aylık dönemde istenen gereksiz fPSA testleri değerlendirildi.

Bulgular: Bilgi mesajı eklendikten sonraki 6 aylık dönemde gereksiz istenen fPSA test sayısı anlamlı olarak azaldı(p <0.05). Bilgilendirme mesajının eklenmesinden sonraki 6 aylık dönemde tPSA test istemi olmadan fPSA test istemi yapılmadı.

Sonuç: Test istemleri yapılırken kılavuzda belirtilen kuralların ve algoritmaların kullanılması oldukça önemlidir. Çalışmamızın sonuçları hastane bilgi sistemine kılavuz önerilerine göre bilgilendirme mesajı eklenmesinin gereksiz test istemlerini azaltabileceğini göstermektedir.

Anahtar Kelimeler

• Gereksiz testler;,serbest PSA;,laboratuvar maliyetleri;,preanalitik faz;

Unnecessary free PSA test requests and assessment of the effectiveness of preventive activities

Abstract

Objective: The aim of our work is to determine unnecessary fPSA test requests according to the European Association of Urology, European Society for Radiotherapy & Oncology guideline (EAPS-ESTRO-SIOG) and to assess the effectiveness of preventive actions we have made due to unnecessary test order.

Methods: According to the guidelines of EAPS-ESTRO-SIOG, the use of fPSA/tPSA ratio is considered clinically insignificant in patients with tPSA >10ng/mL or <4ng/mL. Measurement uncertainty for tPSA was calculated as±15.49% in our laboratory. The limit values(4 and 10 ng/mL)were expanded according to the uncertainty value. fPSA tests ordered in patients with tPSA levels <3.38 and >11.54 ng/mL were considered unnecessary. In addition, if the patient did not have a tPSA test previously performed in another laboratory, the requested fPSA tests in patients without tPSA test in our laboratory was evaluated as unnecessary. An informational message has been added to the hospital information system regarding the guideline recommendation for the fPSA. Unnecessary fPSA tests in the six-month term before and after adding the information note were evaluated.

Results: The number of unnecessary fPSA test significantly decreased in the six-month term after the addition of information note(p<0.05). The fPSA test was not requested without the tPSA test in 6 month period after the addition of the information note.

Conclusion: It is important to use the rules and algorithms mentioned in the guidelines when ordering the test. The results of our study suggest that the addition of an informative message according to the guideline recommendation to the hospital information system can reduce the unnecessary test order.

Keywords

• Unnecessary test;,free PSA;,laboratory costs;,pre-analytical phase;

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