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

Figures & data

Table 1 PT Use in Danish General Practice in 2007–2018

Year	Median Rate (IQI)^c	Person-Years	PTs^b	General Practices (no PTs)^a
2007	18 (6; 41)	4,970,025	158,673	2235 (151)
2008	21 (8; 48)	4,951,283	181,511	2182 (103)
2009	25 (9; 50)	4,903,790	194,858	2148 (116)
2010	31 (13; 62)	4,866,519	232,803	2138 (78)
2011	35 (16; 69)	4,830,258	258,107	2113 (77)
2012	37 (17; 70)	4,807,781	264,307	2088 (64)
2013	35 (17; 63)	4,759,908	238,525	2075 (59)
2014	36 (19; 65)	4,733,175	242,210	2038 (41)
2015	38 (20; 68)	4,711,646	252,914	1997 (38)
2016	36 (19; 65)	4,703,050	239,533	1945 (35)
2017	37 (19; 66)	4,659,775	246,526	1914 (41)
2018	39 (20; 69)	4,625,658	258,926	1881 (39)
Total		57,522,867	2,768,893

Notes: ^aRestricted to practices with more than 500 patients listed per year. ^bNumber of PTs differs between Table 1 and Table 2 due to minor differences in the definition of “active” general practices in the two cohorts. ^cRates are calculated as number of PTs per 1000 person-years.

Abbreviations: IQI, Interquartile interval; PT, psychometric test.

Table 2 Variables of Interest and Their Association with PT Use

Variable	PTs^b	Person-Years	PT Rate^c	IRR^a (95% CI)
Gender
Men	174,600	4,111,875	42	1.00 (ref.)
Women	288,741	4,261,666	68	1.58 (1.55; 1.62)
Age, years
18–24	56,049	880,697	64	1.00 (ref.)
25–34	89,263	1,296,834	69	1.08 (1.05; 1.10)
35–44	75,588	1,322,252	57	0.89 (0.87; 0.92)
45–54	73,533	1,507,975	49	0.76 (0.74; 0.79)
55–64	58,152	1,311,237	44	0.69 (0.66; 0.72)
65–74	46,861	1,195,587	39	0.61 (0.58; 0.64)
75–84	43,951	638,823	69	1.05 (0.99; 1.11)
85-	19,944	220,135	91	1.32 (1.23; 1.42)
Cohabitation status
Single	214,470	3,162,902	68	1.00 (ref.)
Married	174,406	3,950,657	44	0.71 (0.69; 0.73)
Cohabiting	74,465	1,259,982	59	0.86 (0.84; 0.88)
Immigration status
Danish	412,314	7,325,498	56	1.00 (ref.)
Western immigrant	17,981	398,523	45	0.75 (0.71; 0.80)
Non-western immigrant	33,046	649,520	51	0.85 (0.81; 0.89)
Educational level, years
≤10	132,977	2,096,820	63	1.00 (ref.)
10–15	212,838	3,903,133	55	0.90 (0.88; 0.92)
≥16	105,996	2,072,534	51	0.78 (0.75; 0.81)
Unknown (no education registered)	11,530	301,054	38	0.57 (0.54; 0.60)
Family income category (annual)
1st quintile	99,388	1,254,727	79	1.00 (ref.)
2nd quintile	100,028	1,452,678	69	0.89 (0.87; 0.91)
3rd quintile	99,173	1,671,148	59	0.79 (0.77; 0.81)
4th quintile	91,726	1,916,697	48	0.65 (0.63; 0.67)
5th quintile	71,607	2,035,905	35	0.49 (0.47; 0.51)
Negative/no income	1419	42,386	33	0.45 (0.41; 0.48)
Year
2017	223,680	4,154,648	54	1.00 (ref.)
2018	239,661	4,218,893	57	1.05 (1.04; 1.07)
Season
Spring	118,122	2,116,239	56	1.00 (ref.)
Summer	98,500	2,113,307	47	0.84 (0.82; 0.85)
Fall	131,960	2,086,340	63	1.13 (1.12; 1.15)
Winter	114,759	2,057,654	56	1.00 (0.99; 1.01)
Region
North Denmark Region	47,222	835,336	57	1.00 (ref.)
Central Denmark Region	130,103	1,909,830	68	1.20 (0.98; 1.45)
Region of Southern Denmark	95,181	1,819,054	52	0.93 (0.76; 1.12)
Capital Region of Denmark	135,705	2,611,923	52	0.89 (0.75; 1.07)
Region Zealand	55,130	1,197,399	46	0.82 (0.67; 1.01)
Comorbidity
Circulatory system
Hypertension	114,508	1,884,908	61	1.25 (1.23; 1.28)
Dyslipidemia	62,836	1,015,893	62	1.28 (1.25; 1.31)
Ischemic heart disease	31,294	462,952	68	1.38 (1.35; 1.42)
Atrial fibrillation	16,061	244,620	66	1.22 (1.19; 1.25)
Heart failure	6106	93,568	65	1.24 (1.19; 1.29)
Peripheral artery occlusive disease	11,642	167,788	69	1.33 (1.28; 1.38)
Stroke	18,358	232,632	79	1.50 (1.46; 1.55)
Endocrine system
Diabetes mellitus	30,282	491,223	62	1.23 (1.20; 1.26)
Thyroid disorder	26,611	370,517	72	1.19 (1.17; 1.22)
Gout	7683	140,372	55	1.16 (1.12; 1.21)
Pulmonary system and allergy
Chronic pulmonary disease	73,953	1,010,573	73	1.35 (1.33; 1.37)
Allergy	75,376	1,070,522	70	1.31 (1.29; 1.34)
Gastrointestinal system
Ulcer/chronic gastritis	11,165	140,333	80	1.49 (1.43; 1.54)
Chronic liver disease	5257	73,824	71	1.44 (1.36; 1.53)
Inflammatory bowel disease	6732	106,230	63	1.15 (1.11; 1.20)
Diverticular disease of intestine	12,346	171,714	72	1.31 (1.26; 1.37)
Urogenital system
Chronic kidney disease	3883	64,519	60	1.11 (1.05; 1.17)
Prostate disorders	17,207	272,265	63	1.52 (1.48; 1.57)
Musculoskeletal system
Connective tissue disorders	12,195	178,681	68	1.16 (1.12; 1.20)
Osteoporosis	22,134	315,912	70	1.11 (1.08; 1.14)
Painful condition	123,276	1,594,556	77	1.67 (1.63; 1.70)
Hematological system
HIV/AIDS	464	9187	51	1.09 (0.93; 1.28)
Anemias	11,401	143,407	80	1.34 (1.29; 1.39)
Cancers
Cancer	30,231	500,742	60	1.13 (1.10; 1.15)
Neurological system
Vision problem	39,401	554,407	71	1.20 (1.17; 1.23)
Hearing problem	30,724	432,767	71	1.29 (1.26; 1.32)
Migraine	25,808	313,122	82	1.42 (1.39; 1.45)
Epilepsy	10,759	118,138	91	1.68 (1.61; 1.76)
Parkinson’s disease	1357	16,765	81	1.51 (1.36; 1.66)
Multiple sclerosis	1668	29,485	57	1.03 (0.95; 1.11)
Neuropathies	21,168	288,242	73	1.38 (1.34; 1.42)
Mental health conditions
Mood, stress-related, or anxiety disorders	69,873	438,713	159	3.08 (3.01; 3.17)
Psychological distress	166,951	1,109,088	151	3.91 (3.80; 4.03)
Alcohol problems	12,345	102,879	120	2.67 (2.58; 2.78)
Substance abuse	4452	38,667	115	2.13 (2.00; 2.27)
Anorexia/bulimia	3381	24,049	141	1.87 (1.76; 1.98)
Bipolar affective disorder	7172	54,593	131	2.38 (2.25; 2.51)
Schizophrenia or schizoaffective disorder	4327	62,917	69	1.28 (1.17; 1.42)
Dementia	8362	68,502	122	1.84 (1.74; 1.95)

Notes: ^aAdjusted for age, sex, and calendar period. ^bNumber of PTs differs between Table 1 and Table 2 due to minor differences in the definition of “active” general practices in the two cohorts. ^cRates are calculated as number of PTs per 1000 person-years.

Abbreviations: PT, psychometric test; IRR, incidence rate ratio; CI, confidence interval.

Table 3 General Practice Characteristics and Standardized PT Rates

Variable	Level	N Practices (%)	Median sPT (IQI)
Region	North Denmark Region	142 (8.7%)	45 (21; 74)
	Central Denmark Region	341 (21%)	49 (29; 81)
	Region of Southern Denmark	334 (20.6%)	39 (24; 61)
	Capital Region of Denmark	587 (36.1%)	40 (20; 69)
	Region Zealand	220 (13.5%)	35 (20; 61)
GP number	1	186 (13.5%)	44 (21; 76)
	2–5	677 (49.3%)	38 (21; 70)
	6-	510 (37.1%)	42 (28; 64)
Patient population	500–1599	576 (35.5%)	38 (17; 75)
	1600–3199	588 (36.2%)	42 (23; 71)
	3200–4799	282 (17.4%)	41 (29; 63)
	4800-	178 (11%)	47 (30; 67)
Solo practice	No	875 (53.9%)	42 (27; 65)
	Yes	749 (46.1%)	39 (17; 75)

Figure 1 Standardized rates of PT use. Overall (A), regions (B), number of doctors (C), patient population size (D), practice type (E).

Abbreviations: NDR, North Denmark Region; CDR, Central Denmark Region; RSD, Region of Southern Denmark; CRD, Capital Region of Denmark; RZ, Region Zealand.

Figure 2 IRRs of treatment regimens and medicine redemption by decile groups of the observed over expected ratio.