Vanker Naadira, Faull Norman H B
Graduate School of Business, University of Cape Town, Cape Town, South Africa.
Afr J Lab Med. 2017 Mar 24;6(1):453. doi: 10.4102/ajlm.v6i1.453. eCollection 2017.
Challenges and uncertainties with test result interpretation can lead to diagnostic errors. Primary care doctors are at a higher risk than specialists of making these errors, due to the range in complexity and severity of conditions that they encounter.
This study aimed to investigate the challenges that primary care doctors face with test result interpretation, and to identify potential countermeasures to address these.
A survey was sent out to 7800 primary care doctors in South Africa. Questionnaire themes included doctors' uncertainty with interpreting test results, mechanisms used to overcome this uncertainty, challenges with appropriate result interpretation, and perceived solutions for interpreting results.
Of the 552 responses received, the prevalence of challenges with result interpretation was estimated in an average of 17% of diagnostic encounters. The most commonly-reported challenges were not receiving test results in a timely manner (51% of respondents) and previous results not being easily available (37%). When faced with diagnostic uncertainty, 84% of respondents would either follow-up and reassess the patient or discuss the case with a specialist, and 67% would contact a laboratory professional. The most useful test utilisation enablers were found to be: interpretive comments (78% of respondents), published guidelines (74%), and a dedicated laboratory phone line (72%).
Primary care doctors acknowledge uncertainty with test result interpretation. Potential countermeasures include the addition of patient-specific interpretive comments, the availability of guidelines or algorithms, and a dedicated laboratory phone line. The benefit of enhanced test result interpretation would reduce diagnostic error rates.
检验结果解读中的挑战和不确定性可能导致诊断错误。由于基层医疗医生所遇到疾病的复杂性和严重程度各不相同，他们比专科医生更容易出现此类错误。
本研究旨在调查基层医疗医生在检验结果解读方面面临的挑战，并确定应对这些挑战的潜在对策。
向南非的7800名基层医疗医生发放了调查问卷。问卷主题包括医生在解读检验结果时的不确定性、克服这种不确定性所采用的机制、正确解读结果面临的挑战以及对解读结果的可感知解决方案。
在收到的552份回复中，估计平均17%的诊断过程存在结果解读方面的挑战。最常报告的挑战是未及时收到检验结果（51%的受访者）和难以获取既往结果（37%）。面对诊断不确定性时，84%的受访者会对患者进行随访和重新评估或与专科医生讨论病例，67%的受访者会联系实验室专业人员。最有用的检验利用促进因素包括：解释性注释（78%的受访者）、已发表的指南（74%）和专门的实验室热线电话（72%）。
基层医疗医生承认在检验结果解读方面存在不确定性。潜在的对策包括增加针对患者的解释性注释、提供指南或算法以及设立专门的实验室热线电话。加强检验结果解读的益处将降低诊断错误率。
