Department of Clinical Chemistry and Hematology, Zuyderland Medical Centre, Heerlen/Sittard-Geleen, the Netherlands.
Department of Internal Medicine, Zuyderland Medical Centre, Heerlen/Sittard-Geleen, the Netherlands.
Ann Clin Biochem. 2021 Mar;58(2):78-85. doi: 10.1177/0004563220968373. Epub 2020 Oct 27.
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 randomized controlled trials investigating the value of reflective testing in patient management.
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.
In 226 of the 270 cases (84%), reflective testing was considered to be useful for the patient. In the intervention group ( = 148), actual management by the general practitioner was scored as adequate ( = 104; 70%), neutral ( = 29; 20%) or not adequate ( = 15; 10%). In the control group ( = 122), these numbers were 57 (47%), 37 (30%) and 28 (23%). This difference was statistically significant ( < 0.001).
This randomized controlled trial showed a positive effect of reflective testing in primary care patients on the adequacy of their management, as documented in medical records.
反思性检测，即解释、评论并在必要时增加检测，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。然而，目前还没有前瞻性随机对照试验研究反思性检测在患者管理中的价值。
在这项试验中，初级保健患者被随机分配到干预组和对照组。干预组的全科医生会收到实验室专家认为合适的附加检测结果及解释性评论，而对照组的全科医生仅会收到要求的实验室检测结果。对患者的医疗记录进行了为期六个月的随访评估。对于两组患者，主要结局指标（即预期和实际管理措施）均由独立专家小组进行盲法评估，判断为充分、中立或不充分。
在 270 例病例中有 226 例（84%）被认为反思性检测对患者有用。在干预组（ = 148）中，全科医生的实际管理措施被评为充分（ = 104；70%）、中立（ = 29；20%）或不充分（ = 15；10%）。在对照组（ = 122）中，这些比例分别为 57（47%）、37（30%）和 28（23%）。这一差异具有统计学意义（ < 0.001）。
这项随机对照试验显示，在初级保健患者中，反思性检测对管理的充分性有积极影响，这在医疗记录中有明确记录。
