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GP’s perspectives on laboratory test use for monitoring long-term conditions: an audit of current testing practice

BACKGROUND: We have shown previously that current recommendations in UK guidelines for monitoring long-term conditions are largely based on expert opinion. Due to a lack of robust evidence on optimal monitoring strategies and testing intervals, the guidelines are unclear and incomplete. This uncerta...

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Autores principales: Elwenspoek, Martha M. C., Mann, Ed, Alsop, Katharine, Clark, Hannah, Patel, Rita, Watson, Jessica C., Whiting, Penny
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7719260/
https://www.ncbi.nlm.nih.gov/pubmed/33278890
http://dx.doi.org/10.1186/s12875-020-01331-6
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author Elwenspoek, Martha M. C.
Mann, Ed
Alsop, Katharine
Clark, Hannah
Patel, Rita
Watson, Jessica C.
Whiting, Penny
author_facet Elwenspoek, Martha M. C.
Mann, Ed
Alsop, Katharine
Clark, Hannah
Patel, Rita
Watson, Jessica C.
Whiting, Penny
author_sort Elwenspoek, Martha M. C.
collection PubMed
description BACKGROUND: We have shown previously that current recommendations in UK guidelines for monitoring long-term conditions are largely based on expert opinion. Due to a lack of robust evidence on optimal monitoring strategies and testing intervals, the guidelines are unclear and incomplete. This uncertainty may underly variation in testing that has been observed across the UK between GP practices and regions. METHODS: Our objective was to audit current testing practices of GPs in the UK; in particular, perspectives on laboratory tests for monitoring long-term conditions, the workload, and how confident GPs are in ordering and interpreting these tests. We designed an online survey consisting of multiple-choice and open-ended questions that was promoted on social media and in newsletters targeting GPs practicing in UK. The survey was live between October–November 2019. The results were analysed using a mixed-methods approach. RESULTS: The survey was completed by 550 GPs, of whom 69% had more than 10 years of experience. The majority spent more than 30 min per day on testing (78%), but only half of the respondents felt confident in dealing with abnormal results (53%). There was a high level of disagreement for whether liver function tests and full blood counts should be done ‘routinely’, ‘sometimes’, or ‘never’ in patients with a certain long-term condition. The free text comments revealed three common themes: (1) pressures that promote over-testing, i.e. guidelines or protocols, workload from secondary care, fear of missing something, patient expectations; (2) negative consequences of over-testing, i.e. increased workload and patient harm; and (3) uncertainties due to lack of evidence and unclear guidelines. CONCLUSION: These results confirm the variation that has been observed in test ordering data. The results also show that most GPs spent a significant part of their day ordering and interpreting monitoring tests. The lack of confidence in knowing how to act on abnormal test results underlines the urgent need for robust evidence on optimal testing and the development of clear and unambiguous testing recommendations. Uncertainties surrounding optimal testing has resulted in an over-use of tests, which leads to a waste of resources, increased GP workload and potential patient harm. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12875-020-01331-6.
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spelling pubmed-77192602020-12-07 GP’s perspectives on laboratory test use for monitoring long-term conditions: an audit of current testing practice Elwenspoek, Martha M. C. Mann, Ed Alsop, Katharine Clark, Hannah Patel, Rita Watson, Jessica C. Whiting, Penny BMC Fam Pract Research Article BACKGROUND: We have shown previously that current recommendations in UK guidelines for monitoring long-term conditions are largely based on expert opinion. Due to a lack of robust evidence on optimal monitoring strategies and testing intervals, the guidelines are unclear and incomplete. This uncertainty may underly variation in testing that has been observed across the UK between GP practices and regions. METHODS: Our objective was to audit current testing practices of GPs in the UK; in particular, perspectives on laboratory tests for monitoring long-term conditions, the workload, and how confident GPs are in ordering and interpreting these tests. We designed an online survey consisting of multiple-choice and open-ended questions that was promoted on social media and in newsletters targeting GPs practicing in UK. The survey was live between October–November 2019. The results were analysed using a mixed-methods approach. RESULTS: The survey was completed by 550 GPs, of whom 69% had more than 10 years of experience. The majority spent more than 30 min per day on testing (78%), but only half of the respondents felt confident in dealing with abnormal results (53%). There was a high level of disagreement for whether liver function tests and full blood counts should be done ‘routinely’, ‘sometimes’, or ‘never’ in patients with a certain long-term condition. The free text comments revealed three common themes: (1) pressures that promote over-testing, i.e. guidelines or protocols, workload from secondary care, fear of missing something, patient expectations; (2) negative consequences of over-testing, i.e. increased workload and patient harm; and (3) uncertainties due to lack of evidence and unclear guidelines. CONCLUSION: These results confirm the variation that has been observed in test ordering data. The results also show that most GPs spent a significant part of their day ordering and interpreting monitoring tests. The lack of confidence in knowing how to act on abnormal test results underlines the urgent need for robust evidence on optimal testing and the development of clear and unambiguous testing recommendations. Uncertainties surrounding optimal testing has resulted in an over-use of tests, which leads to a waste of resources, increased GP workload and potential patient harm. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12875-020-01331-6. BioMed Central 2020-12-05 /pmc/articles/PMC7719260/ /pubmed/33278890 http://dx.doi.org/10.1186/s12875-020-01331-6 Text en © The Author(s) 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research Article
Elwenspoek, Martha M. C.
Mann, Ed
Alsop, Katharine
Clark, Hannah
Patel, Rita
Watson, Jessica C.
Whiting, Penny
GP’s perspectives on laboratory test use for monitoring long-term conditions: an audit of current testing practice
title GP’s perspectives on laboratory test use for monitoring long-term conditions: an audit of current testing practice
title_full GP’s perspectives on laboratory test use for monitoring long-term conditions: an audit of current testing practice
title_fullStr GP’s perspectives on laboratory test use for monitoring long-term conditions: an audit of current testing practice
title_full_unstemmed GP’s perspectives on laboratory test use for monitoring long-term conditions: an audit of current testing practice
title_short GP’s perspectives on laboratory test use for monitoring long-term conditions: an audit of current testing practice
title_sort gp’s perspectives on laboratory test use for monitoring long-term conditions: an audit of current testing practice
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7719260/
https://www.ncbi.nlm.nih.gov/pubmed/33278890
http://dx.doi.org/10.1186/s12875-020-01331-6
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