Utilisation and trends of laboratory testing and point-of-care testing in primary care in Germany : an analysis of claims data

Objectives: German general practitioners (GPs) either order laboratory tests from external laboratories (initiated laboratory services (ILS)) or perform point-of-care tests (POCTs) within the GP practice. This study investigated the current use and time trends of laboratory testing in German GP practices with a particular focus on POC testing.

Design: Retrospective consecutive cross-sectional study by analysis of complete outpatient healthcare claims data (2017–2022). Setting Primary care in Thuringia, a federal state in central Germany. Participants Data from 2061 GPs.

Primary and secondary outcome measures: Number of performed laboratory analyses per year, mean number of laboratory analyses per patient and year.

Results: In 2022, 1601 GPs performed 16.1 million laboratory analyses, with 14.9 million (92.5%) being ILS and 1.2 million (7.5%) being POCTs conducted within GP practices. The mean number of laboratory tests per patient was 15.5 in 2022. The number of laboratory tests performed per patient decreased by 18.8% from 2017 to 2022. An especially pronounced reduction was observed in the use of POCTs (−36.0%). During the whole study period, the most common initiated laboratory analyses included creatinine, blood cell count, glucose, thyroid-stimulating hormone and HbA1/HbA1c. The most frequently employed POCTs were glucose, urine test strip, prothrombin time/international normalised ratio, HbA1/HbA1c, erythrocyte sedimentation rate and microalbuminuria. POC testing instead of ILS was more likely performed in older patient groups (≥40 years) compared with young adult patients (18–39 years) (adjusted OR (aOR) 40–59 years: 1.19 (95% CI 1.14 to 1.24); aOR 60–79 years: 1.48 (95% CI 1.40 to 1.57); aOR >79 years: 1.43 (95% CI 1.34 to 1.54)).

Conclusions: German GPs regularly employ laboratory testing, primarily utilising external laboratory service, while POC testing plays a relatively minor role. The notable decline in the use of POCT testing may be attributed to several factors, including regulations from healthcare authorities, reimbursement guidelines and increasing test costs.