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Arnold M. Epstein, MD, MA; Robert M. Hartley, MD, MSc; John R. Charlton, MSc; Conrad M. Harris, MEd, FRCP; Brian Jarman, MRCP, MRCGP; Barbara J. McNeil, MD, PhD

JAMA. 1984;252(13):1723-1726.

Abstract
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.

(JAMA 1984;252:1723-1726)

Author Affiliations
From the Department of Medicine, Division of General Medicine (Drs Epstein and Hartley), and the Departments of Radiology, and Preventive Medicine and Clinical Epidemiology (Dr McNeil), the Brigham and Women's Hospital and Harvard Medical School, and the Institute for Health Research, Harvard School of Public Health (Dr Epstein), Boston; and St Thomas' Hospital Medical School (Dr Charlton) and St Mary's Hospital Medical School (Drs Harris and Jarman), London. Dr Epstein is a Medical Foundation Fellow, 1982 to 1984, and Dr Hartley is a Milbank Memorial Fund Scholar.

Footnotes
Reprint requests to Department of Medicine, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115 (Dr Hartley).

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