Fast laboratory test results alone cannot deliver the benefits of near patient testing: a follow-up study after 3 years of extended laboratory service at a primary health care centre.
OBJECTIVE
Technological development has progressed towards point-of-care testing (POCT) at primary health care centres (PHCs). However, to our knowledge, there has been no extensive evaluation of the effects on patient and clinical logistics when an extended laboratory service (ELS) is offered.


METHODS
Questionnaires were used to evaluate patient logistics before the introduction of ELS and after 6 months, as the proportion of consultations completed within one visit. That is, the patient is sampled, the test result is made available, and the patient is informed of the clinical decision. After 3 years of ELS, clinical logistics were followed up using questionnaires and by measuring turnaround time (TAT) from sampling to available test result (TATa) and from sampling to a clinical decision (TATd), and the proportion of laboratory test results reported back to the patient on the day of sampling (TATi).


RESULTS
After 6 months of ELS, the theoretical proportion of consultations which could be completed within 1 day had increased from 20% to 68%, while the proportion of patients desiring this situation had increased from 72% to 85%. After 3 years of ELS, the TATi was 56%. However, the majority of these tests were from the menu available before ELS. While 66% of patients wished to receive the laboratory test results at the consultation, this was achieved in 42% of cases. Patients below 65 years of age were more anxious than older patients to complete the consultation within a single PHC visit.


CONCLUSIONS
The clinical logistics concerning TATi did not correspond to the patients' wishes. When the consultation was completed within 1 day, the majority of the laboratory analyses were from the menu available before ELS. An ELS alone cannot deliver all the desired benefits of POCT.
Haglund
Sofie
S
Division of Laboratory Medicine, Deparment of Research and Development in Laboratory Medicine, Clinical Chemistry, Ryhov Hospital, Jönköping County Council, Swenden. sofie.haglund@lj.se
Transö
Bente
B
Persson
Lars-Göran
LG
Zafirova
Tamara
T
Grodzinsky
Ewa
E