Variation in Psychometric Testing in General Practice – A Nationwide Cohort Study

Abstract

Objective

Most mental disorders are diagnosed and treated in general practice. Psychometric tests may help the general practitioner diagnose and treat mental disorders like dementia, anxiety, and depression. However, little is known about the use of psychometric tests in general practice and their impact on further treatment. We aimed to assess the use of psychometric tests in Danish general practice and to estimate whether variation in use is associated with the provided treatment and death by suicide in patients.

Methods

This nationwide cohort study included registry data on all psychometric tests performed in Danish general practice in 2007–2018. We used Poisson regression models adjusted for sex, age, and calendar time to assess predictors of use. We used fully adjusted models to estimate the standardized utilization rates for all general practices.

Results

A total of 2,768,893 psychometric tests were used in the study period. Considerable variations were observed among general practices. A positive association was seen between a general practitioner’s propensity to use psychometric testing and talk therapy. Patients listed with a general practitioner with low use had an increased rate of redeemed prescriptions for anxiolytics [incidence rate ratio (95% confidence interval):1.39 (1.23;1.57)]. General practitioners with high use had an increased rate of prescriptions for antidementia drugs [1.25 (1.05;1.49)] and first-time antidepressants [1.09 (1.01;1.19)]. High test use was seen for females [1.58 (1.55; 1.62)] and patients with comorbid diseases. Low use was seen for populations with high income [0.49 (0.47; 0.51)] and high educational level [0.78 (0.75; 0.81)].

Conclusion

Psychometric tests were used mostly for women, individuals with a low socioeconomic status, and individuals with comorbid conditions. The use of psychometric tests depends on general practice and is associated with talk therapy, redemptions for anxiolytics, antidementia drugs, and antidepressants. No association was found between general practice rates and other treatment outcomes.

Keywords:

• psychometric tests
• registries
• general practice
• mental disorders
• treatment variation

Abbreviations

ATC, Anatomical therapeutic chemical; CDR, Central Denmark Region; CI, Confidence interval; CRD, Capital Region of Denmark; DCRS, Danish Civil Registration System; DNPR, Danish National Prescription Register; GP, General practitioner; ICD-10, International Classification of Diseases, 10th revision; IQI, Interquartile interval; IQR, Interquartile range; IRR, Incidence rate ratios; m, Model; NHISR, (Danish) National Health Insurance Service Register; NDR, North Denmark Region; NPR, (Danish) National Patient Register; OE, Observed over expected; PT, Psychometric test; RSD, Region of Southern Denmark; RZ, Region Zealand; sPT rate, Standardized psychometric test rate.

Data Sharing Statement

Due to restrictions related to Danish law and protection of patient privacy, the data used in this study can only be made available through a trusted third party, Statistics Denmark, which holds the data records for this study. Research groups based in a Danish scientific setting can be authorized to work with data within Statistics Denmark. Access to individual scientists inside and outside of Denmark may be authorized upon request directed to Statistics Denmark.

Ethics Statement

The study required no approval from the Committee on Health Research Ethics in the Central Denmark Region as it was based on register data, and all patient information was anonymized and de-identified prior to analysis by Statistics Denmark.

Acknowledgments

The authors would like to thank Lone Niedziella for language editing, and Statistics Denmark for providing the data infrastructure.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

HSP was funded by an unrestricted grant from the General Practice Research Foundation of the Central Denmark Region (Region Midtjyllands Praksisforskningsfond). AP was funded by the Novo Nordisk Foundation (grant no. NNF18OC0031194). The funders had no role in the study design, data collection, data analysis, data interpretation, or writing of the paper.