Blood tests in General Practice.

Rates of blood testing are rising in primary care. Blood tests are important for diagnosis and monitoring, but tests in themselves do not make people better, unless actions based on the test result lead to a change in patient management or reassurance. Both are dependent on test result communication.

 

Why rising? Free POC, CDM, complexity, aging, multimorbidity, to close consultations, cascade effect etc

 

The 10 commandments

1.Consider that you cannot diagnose everything with laboratory testing.

2.Defensive medicine is not a good reason for prescribing a test.

3.Excessive testing can be harmful for your patient.

4.Use a Bayesian approach for diagnostic testing (pre-test probability).

5.The timing of bloods.

6.Be aware of the limitations of the test and inform pt.

7.Consider the influence of preanalytical problems of test results.

8.Consider test result(s) according to the clinical situation.

9.Policy in place.

10.Requesting blood tests is a clinical responsibility.

 

 

Decision to take in setting up a system for taking bloods.

  • Registration on healthlink.
  • Labelling, peripherals etc.
  • Lab Guide.
  • Costs and charges.
  • Ensuring bloods get to the lab – on time.
  • Safety statement.
  • Ensuring sample results come back to practice.
  • Ensuring results get considered and actioned.
  • Ensuring results go to patients.
  • Confidentiality / GDPR.
  • Absence protocols – no result, can’t contact pt etc.
  • Loop systems of ensuring results return.

The testing triad.

  1. Delegation of responsibility – who can request a blood test?
  2. Delegation of tasks – who can give interpret / who can give results?
  3. How are results given? - Text results/Phone/E-mail /Face to Face.

 

Special circumstances.

Clinical Scenarios seemingly endless. WTDWYDKWTD?

Judicious / Appropriate use of testing / Resource implications.

Interface between primary and secondary care – whose responsibility?

Blood monitoring of special drugs by protocols?

Workload significant. Ring fenced time.

Unsolicited results?

OOH results.

 

 

The why test study 2024.

Investigation of symptoms 43.2 %.

Monitoring of existing disease 30.1%.

Monitoring of medications 10.1%.

25% considered unnecessary by expert opinion.

50% not directly ordered by the GP.

4.5 tests ordered simultaneously per patient.

26.0 % completely normal.

6.2% led to a new diagnosis or confirmed a diagnosis.

48.8% did not lead to a new diagnosis or confirmation of a diagnosis.

 

 

Vampire Study (vague medical problems in research)

Somatic illnesses detectable by blood-test ordering (for example, diabetes mellitus, hypothyroidism); 8%

Value in deferring bloods in case of fatigue.