Effectiveness of adding additional tests and/or comments to laboratory reports in a patient population, referred by general practitioners to the clinical chemistry laboratory.

Reflective testing is not a routine in the Netherlands. It is common practice in the UK, where such post-analytical processing is integral to the provision of a quality service, and as such is a requirement for laboratory accreditation there. However, evidence of the effectiveness of this procedure is very limited. In the present situation, the laboratories in the Netherlands do deliver extra services additional to reporting of test results. It is common practice to report strongly abnormal results directly by phone to the physician. In some special test procedures (e.g. bone marrow investigation, flow cytometry, hemoglobinopathies) the laboratory professional is more involved in the diagnostic procedure, and test results are supplemented with an interpretative comment. Reflective testing would add a new dimension to the service of the clinical chemistry laboratory to primary health care. It is a potential powerful tool for completing the diagnostic process.

Most of the reports of patients in general practice do not have abnormal test results, or have minor abnormal results not needing special attention. About 15 % of the reports do have abnormal results that need the attention of a laboratory professional. About 3 % of all reports are subject to reflective testing.

The goal of this project is the investigation of the effectiveness of reflective testing (the intervention: adding additional test results and/or comments to the test report) compared with routine care (the traditional report, without additional testing or comments being sent to the general practitioner), in a patient population referred by general practitioners to the clinical chemistry laboratory.

The goal of this project is the investigation of the effectiveness of reflective testing (the intervention: adding additional test results and/or comments to the test report) compared with routine care (the traditional report, without additional testing or comments), in a patient population, referred by general practitioners to the clinical chemistry laboratory.

Measurements will be done after a follow-up period of 6 months.

Study design: a randomised clinical trial with reports with reflective testing vs. traditional reports. The randomisation of reports will be performed after the laboratory specialist has done the additional testing and commenting. All selected laboratory results will be subject to reflective testing but only in half of the cases the general practitioners will receive the report. After a follow-up period of 6 months, the differences in diagnostic and therapeutic actions of the general practitioners will be investigated.