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. Patients’ 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.

背景

反射性测试，即解释，注释和必要时添加测试，以有意义且有效的方式辅助诊断过程，是实验室医学提供的一项额外服务。但是，尚无前瞻性随机对照试验研究反射测试在患者管理中的价值。

方法

在该试验中，基层医疗患者被随机分配到干预组，在该组中，全科医生根据要求接受实验室检查结果，并在实验室专家认为适当的情况下将其附有解释性评论的附加测试结果分配给干预组，或随机分配给全科医生仅收到要求的实验室测试结果。患者？？？对病历进行了六个月的随访评估。对于这两组，主要结果指标（即预期措施和实际管理措施）均由独立专家小组盲目评估为适当，中立或不足。

结果

在270例病例中，有226例（84％）被认为对患者有用。在干预组（n = 148）中，全科医生的实际管理被评定为适当（n = 104； 70％），中立（n = 29； 20％）或不适当（n = 15； 10％）。在对照组（n = 122）中，这些数字分别为57（47％），37（30％）和28（23％）。这种差异具有统计学意义（p <0.001）。

结论

这项随机对照试验显示，如医疗记录所示，对初级保健患者进行反思性测试对其管理充分性具有积极作用。