Perspectives on laboratory tests in chronic disease monitoring: preliminary results from a survey among GPs across UK

Conference:

2020 SW SAPC Bristol

Talk Code:

1D.5

Presenter:

Martha MC Elwenspoek

Twitter:

@MarthaElwen

Co-authors:

Martha MC Elwenspoek, Ed Mann, Katharine Alsop, Rita Patel, Jessica C Watson, Penny Whiting

Author institutions:

The National Institute for Health Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol NHS Foundation Trust; Population Health Sciences, Bristol Medical School, University of Bristol; Nightingale Valley Practice; Brisdoc Healthcare Services; Tyntesfield Medical Group.

Problem

We have shown previously that current recommendations in UK guidelines for monitoring chronic diseases 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.

Approach

Our objective was to better understand GP perspectives on laboratory tests in chronic disease monitoring, the workload, and how confident GPs are in ordering and interpreting these tests. We designed an online survey that was promoted on social media and in newsletters targeting GPs.

Findings

The survey has been completed by 525 GPs of which 69% had more than 10 years of experience as a GP. Over half of respondents reported that they spend over 45 mins per day reviewing laboratory results, with 28% spending over an hour. The majority of respondents reported that they think we currently do too many tests to monitor chronic diseases. There was acceptance that monitoring for chronic disease can be harmful for patients with 29% saying they thought it would frequently be harmful. There was also substantial variation in what tests GPs routinely or sometimes offer for hypertension, type 2 diabetes and chronic kidney disease, especially around liver function tests, full blood count, lipid profile, thyroid function tests and cholesterol. Only 52% felt confident in what to do with abnormal incidental findings picked up during chronic disease monitoring.

Consequences

Although these are only preliminary findings, the response rate is high for a survey of busy clinicians, suggesting that optimising testing in primary care is an important topic for GPs. 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.

Submitted by:

Martha Elwenspoek

Funding acknowledgement:

This research was supported by the National Institute for Health Research (NIHR) Applied Research Collaboration West (NIHR ARC West). The views expressed in this article are those of the author(s) and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care. JW is funded by a Doctoral Research Fellowship from the National Institute for Health Research (NIHR-2016-09-034).