A comparison of ambulatory test ordering for hypertensive patients in the United States and England
A. M. Epstein, R. M. Hartley, J. R. Charlton, C. M. Harris, B. Jarman and B. J. McNeil
We compared British and American patterns of ambulatory testing for chronic
uncomplicated hypertensive patients by examining test use for 351 American
patients cared for by 30 community-based internists in Massachusetts and
511 British patients cared for by 18 general practitioners in Greater
London. For each of 13 tests examined, utilization was equal or higher for
American patients. Significantly more ECGs, chest roentgenograms, plain
roentgenograms (other than chest roentgenograms), blood cell counts,
urinalyses, cervical cytological tests, barium enema examinations, and
intravenous pyelograms were ordered. Differences ranged from four to 40
times higher in the United States. This investigation documents a marked
difference in test use. Further study is needed to determine whether the
conservative use of diagnostic services adversely affects patient outcomes
or represents a more cost-effective form of care.
