Gereksiz serbest PSA test istemleri ve önleyici faaliyetlerin etkinliğinin değerlendirilmesi

Year 2019, Volume: 12 Issue: 3, 395 - 400, 30.09.2019

Nergiz Zorbozan , İlker Akarken , Gökçe Filiz Atikeler

https://doi.org/10.31362/patd.535320

Abstract

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.

Keywords

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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