Communicating blood test results in primary care: a mixed methods systematic review

Conference:

SAPC ASM 2024 - Bristol

Talk Code:

10F.2

Presenter:

Helen Nankervis

Co-authors:

A. Huntley 1, P. Whiting 1, W. Hamilton 2, H. Singh 3, S. Dawson 1, R. O’Donnell 1, J. Sprackman 1, A. Ferguson-Montague 1, J. Watson 1 

Author institutions:

1 University of Bristol, UK,  2 University of Exeter, UK , 3 Baylor College of Medicine, USA 

Problem

Safe and efficient systems for test result communication are especially important given the rising primary care workload, with the average UK GP spending 1.5 to 2 hours per day reviewing and actioning test results.  We aimed to assess the factors impacting communication of blood test results between primary care providers, their patients and carers. We reviewed the benefits and harms of interventions for improving communication, evaluated needs and preferences of patients, clinicians and healthcare staff, and identified barriers and facilitators for communication.

Approach

We registered (PROSPERO CRD42023427433) and published the protocol for this mixed methods systematic review. Medline, Embase, PsycINFO (Ovid), CINAHL (EBSCOHost) and the Cochrane Library were searched from 2013 to 2023. Primary studies of any design providing information on the communication of blood test results by primary care to adult patients and carers were included. PPI participants, including two co-authors, participated in the design and conduct of the review. The review synthesis was conducted following JBI guidance for mixed methods systematic reviews using a segregated convergent approach.

Findings

71 studies were included; most were cross-sectional, observational and 29/71 focused on online communication. Study quality was mostly poor and risk of bias was high, partly due to a lack of reported information. While online access and text messages were considered acceptable for routine or normal results by patients, clinicians and healthcare staff; some considered them impersonal. Patients wanted more information about their results and consulted various sources to try to obtain this. Patients preferred shorter waiting times for test results with some exceptions around sensitive results. Clinicians and healthcare staff were concerned about incorrect contact details when using text messaging, emails or voice messages. Opinions were mixed as to whether more information with test results and direct release to patients without clinician input was beneficial or could cause problems. Barriers included cost, time and unclear processes, such as who was responsible for follow-up. Additional barriers included the burden of test communication management systems including use of workarounds, alerts and notifications. We did not identify any interventions to improve communication of blood test results due to a lack of interventional studies and randomized controlled trials.

Consequences

Blood test result communication needs, preferences, barriers and facilitators were diverse and included important common themes, useful for directing clinical and research focus. There was little relevant evidence around online access as studies often selected for current online users, online access and skills. The findings are significant given that the NHS in England has recently mandated online patient access to test results in primary care. The impact of these changes on diverse patient groups, including those at risk of digital exclusion, warrants further exploration.

Submitted by:

Helen Nankervis

Funding acknowledgement:

This project is funded by the National Institute for Health and Care Research (NIHR) School for Primary Care Research (project reference 600). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.