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It's High Time to Normalize Pre-Visit Lab Testing

Commentary
Article

In today’s rapidly changing health care landscape, clinicians are under increasing pressure to improve health outcomes and to enhance the patient experience. It’s a daunting challenge for medical practices in the face of endless administrative burdens and a growing shortage of health care workers.

Andrew Carroll, MD

Babson Diagnostics Clinical Advisor

Andrew Carroll, MD

Babson Diagnostics Clinical Advisor

Patients today expect a modern experience that easily assimilates into their digital lives and meets their increasing focus on health and wellness. They are also notorious for skipping needed testing and not following up on care when it’s inconvenient.

A few years ago, the American Medical Association (AMA) recommended an innovative solution to medical practices that would save time and improve patient care. The organization advocated that patients get laboratory tests done before an office visit.

Previsit labs are a significant change from standard practice. Like most physicians, I was used to seeing patients first and then sending them to the lab for bloodwork after the appointment. Since most medical decisions rely on blood work and other laboratory testing, adopting a new workflow would be challenging. Besides, I had been practicing this way for a long time.

Saves time, supports face time

But the AMA made a strong case for lab visits before office visits to become the new standard. Ordering tests and sending patients to a lab after the visit is inefficient for everyone involved. Clinicians and their staff spend much time following up with patients to discuss test results. If results are abnormal, the follow-up often consists of many back-and-forth phone calls and emails because patients typically have questions.

Research also shows that when patients can discuss their lab results with their clinician during a visit, they have an improved experience and become more personally involved in their health care decisions. A positive patient experience is associated with higher levels of adherence to recommended prevention and treatment plans and better health outcomes.

A win-win, right? I took the plunge and became a believer. But previsit labs have not become standard practice in the medical community. One survey of 210 physicians reported that they ordered blood work before seeing patients for about 40% of in-person visits.

In my time on the board of directors of the American Academy of Family Physicians, I came across colleagues who still had some questions about ordering labs prior to a patient’s appointment.

Of course, there are always barriers to change. But the challenges that clinicians face in our health care system are immense. Many factors, including heavy caseloads and administrative responsibilities, have lengthened workdays and squeezed compensation. Even small administrative changes can make health care easier for patients and clinicians. Taking the time to integrate previsit lab testing is an investment worth making.

Evidence-based practice

For one, previsit labs increase office productivity. One case study found that the advance testing reduced the number of phone calls about lab results by 89% and the number of letters required to communicate lab results by 85%. There were also significantly fewer revisits and fewer lab tests ordered. This saved the practice $25 per visit in physician and team time.

I have found that previsit labs work best before annual wellness exams. The blood work done as part of these visits involves some of the most common tests ordered, such as a complete blood count, a metabolic panel, a lipid panel, and a thyroid panel. The results of these tests are usually available in a few days, if not sooner.

The Mayo Clinic found that ordering previsit lab work is a simple but powerful way to improve the value of periodic health examinations in an internal medicine primary care practice setting. The health system conducted a study with approximately 600 patients and found that 87.8% of patients completed their routine tests before the exam, and most of them (61%) preferred the process over the typical method of getting tests done after the office visit. Many of those who liked the previsit labs had abnormal test results and benefitted “from face-to-face discussion of these results directly with their provider,” according to the study. Previously, most patients would have only received test results by telephone from a nurse or other clinic staff.

The study also highlighted another benefit of testing before the visit: developing a patient-centered plan to manage the results of abnormal tests. “Not only does the patient have the opportunity to question the provider about further tests and consultations, but the provider, in turn, is able to fulfill the role expected of them in the medical home model by visibly showing the patient their active role in coordinating care,” the study said.

There are some simple steps clinicians can take to make this happen. In fact, the AMA has a toolkit on its website that walks through the process. Making lab testing more convenient and accessible will encourage patients to get tests done before an office visit.

Clinicians have to help patients get the most out of testing and the vital health information it provides. It’s not enough to give them access to accurate data. Patients need and expect their clinicians to help them understand and use their test results in a meaningful way. The payoff is a better patient experience and more sustainable medical practices.


Andrew Carroll, MD, is a family physician and clinical assistant professor at the University of Arizona College of Medicine. Dr Carroll is a leading voice in family medicine, having served on the board of directors of the American Academy of Family Physicians, a professional organization representing more than 130 000 doctors. He also has extensive experience in the areas of new healthcare delivery models, healthcare information technology, and medical informatics.


References

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