Do interpretative comments influence patient management and do our users approve of the laboratory ‘adding on’ requests? A follow-up General Practitioner and Nurse Practitioner survey

Barlow, Ian M

doi:10.1258/acb.2008.008174

Cited by 16 publications

(8 citation statements)

References 4 publications

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“…There have been several studies by other researchers as well as our group, supporting the usefulness of reflective testing, as shown by a positive appreciation of physicians 5–8 and patients, 9 and by a learning effect in physicians. 10 The results of these studies were largely based on retrospective studies and questionnaires that documented an evaluation of reflective testing by the stakeholders.…”

Section: Introductionsupporting

confidence: 65%

Reflective testing – A randomized controlled trial in primary care patients

et al. 2020

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BACKGROUND Reflective testing i.e. interpreting, commenting on and, if necessary, adding tests in order to aid the diagnostic process in a meaningful and efficient manner, is an extra service provided by laboratory medicine. However, there have been no prospective randomised controlled trials investigating the value of reflective testing in patient management. METHODS In this trial, primary care patients were randomly allocated to an intervention group where general practitioners received laboratory tests results as requested as well as add-on test results with interpretative comments where considered appropriate by the laboratory specialist, or to a control group where general practitioners only received the laboratory test results requested. Patientsâ medical records were evaluated with a follow-up period of six months. For both groups, the primary outcome measures i.e. both intended action and actual management action, were blindly assessed by an independent expert panel as adequate, neutral or inadequate. RESULTS In 226 of the 270 cases (84%) reflective testing was considered to be useful for the patient. In the intervention group (n=148), actual management by the general practitioner was scored as adequate (n=104; 70%), neutral (n=29; 20%) or not adequate (n=15; 10%). In the control group (n=122), these numbers were 57 (47%), 37 (30%) and 28 (23%). This difference was statistically significant (p<0.001). CONCLUSION This randomised controlled trial showed a positive effect of reflective testing in primary care patients on the adequacy of their management, as documented in medical records.

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Section: Introductionsupporting

confidence: 65%

Reflective testing – A randomized controlled trial in primary care patients

et al. 2020

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“…4,5 It has also been established in a UK service that over 75% of the recipients of report comments feel they influence patient management, for some tests at least. 6 In a separate study, a temporal relationship between the introduction of thyroid comments and a subsequent reduction in the proportion of patients inadequately replaced with levothyroxine has been found. 7 In contrast, an Australasian study found a worryingly large proportion of comments could be inappropriate or, in some cases, potentially dangerous.…”

Section: Discussionmentioning

confidence: 95%

A national survey of interpretative reporting in the UK

Freedman

2011

Ann Clin Biochem

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Aims: There is still debate as to whether the addition of interpretative comments to laboratory reports can influence the management of patients. Little is known about the extent of this activity in individual laboratories throughout the UK and so this national survey aimed to establish the prevalence. Methods: An electronic questionnaire was sent to 196 NHS laboratories in the UK asking whether 17 commonly requested groups of tests were reported with interpretative comments and, if so, how laboratory computers and/or humans were involved in the process. Enquiries were also made of the grades of staff performing the process and of any 'vignette' examples where interpretative reporting had improved the clinical outcome for the patient. Results: A total of 138 of the 196 laboratories (70%) responded. Only two laboratories did not have staff adding interpretative comments to any of the 17 tests. Consultant laboratory staff reporting predominated in all tests with a significant minority also being added by biomedical scientists. High-volume requests usually had staff adding comments to results selected by computer rules whereas more of the specialist endocrine tests tended to be considered for comment. Only six of 71 vignettes referred specifically to 'routine' biochemistry. Conclusions: The addition of interpretative comments onto clinical biochemistry reports is widespread throughout the UK. This service is largely consultant led. There is anecdotal evidence that the process can influence the clinical management of patients.

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“…Although reflective and reflex comments on laboratory reports are widespread 7,8 and generally appreciated by clinicians and the public, [11][12][13] evidence for their effectiveness is limited. 7,8 Reflective testing is a process whereby a laboratory specialist adds additional tests or individualised interpretative comments or both to aid the diagnosis and management of individual patients.…”

Section: Discussionmentioning

confidence: 99%

Do reflex comments on laboratory reports alter patient management?

et al. 2020

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Introduction Laboratory comments appended on clinical biochemistry reports are common in the UK. Although popular with clinicians and the public, there is little evidence that these comments influence the clinical management of patients. Methods We provided reflex automated laboratory comments on all primary care lipid results including, if appropriate, recommendation of direct referral to the West Midlands Familial Hypercholesterolaemia service (WMFHS). Over a two-year period, the number GP referrals from the Wolverhampton City Clinical Commissioning Group (CCG) to the WMFHS were compared with four comparator CCGs of similar population size, who were not provided with reflex laboratory comments. Results Over the study period, the WMFHS received more referrals from Wolverhampton GPs (241) than any other comparator CCG (range 8–65) and greater than the combined referrals (172) from all four comparator CCGs. Conclusion Targeted reflex laboratory comments may influence the clinical management of patients and may have a role in the identification of individuals with familial hypercholesterolaemia.

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Do interpretative comments influence patient management and do our users approve of the laboratory ‘adding on’ requests? A follow-up General Practitioner and Nurse Practitioner survey

Cited by 16 publications

References 4 publications

Reflective testing – A randomized controlled trial in primary care patients

Reflective testing – A randomized controlled trial in primary care patients

A national survey of interpretative reporting in the UK

Do reflex comments on laboratory reports alter patient management?

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