Africa Centre for Health and Population Studies, University of KwaZulu Natal, Durban, South Africa.
J Clin Pathol. 2009 Oct;62(10):935-8. doi: 10.1136/jcp.2009.069062.
To identify priorities for improving effective use of laboratory services in a district hospital in Malawi.
A prospective observational study of clinician-patient interactions to analyse laboratory test requesting practices and utilisation of laboratory results. The proportion of tests that was appropriately ordered, processed and ultimately influenced clinical management was used to assess effectiveness of utilisation.
420 clinical consultations between health professionals and patients were observed. 92% of tests were ordered appropriately, 84% were processed by the laboratory and 64% of results influenced patient management. 73-79% of high-volume tests (haemoglobin, microscopy for malaria and tuberculosis) and 32% of low-volume tests influenced management.
25% of commonly requested laboratory tests were not utilised effectively; because of the high volume, interventions to improve their use are likely to be cost effective. Although 68% of low-volume tests were not used efficiently, the cost of providing support for these tests in a resource-poor setting needs to be balanced against their clinical usefulness. In contrast to published information, this study shows significant under-requesting of laboratory tests that were available. Measures to increase appropriate test requests will have implications for clinician education as well as laboratory space, budgets and staffing levels.
确定在马拉维一家地区医院提高实验室服务有效利用的优先事项。
对临床医生-患者互动进行前瞻性观察研究，以分析实验室检测请求实践和实验室结果的利用情况。评估利用效果的标准是评估检测的适当性、处理和最终对临床管理的影响程度。
观察了 420 次卫生专业人员和患者之间的临床咨询。92%的检测是适当的，84%的检测由实验室进行，64%的结果影响了患者的管理。高容量检测（血红蛋白、疟疾和结核病显微镜检查）的 73-79%和低容量检测的 32%影响了管理。
25%的常用实验室检测未得到有效利用；由于数量巨大，改善其使用的干预措施可能具有成本效益。尽管 68%的低容量检测未得到有效利用，但在资源匮乏的环境中为这些检测提供支持的成本需要与其临床有用性相平衡。与已发表的信息不同，本研究显示出实验室检测的明显不足，这些检测是可用的。增加适当检测请求的措施将对临床医生的教育以及实验室空间、预算和人员配备水平产生影响。
