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Electronic letters published:
![[Read Comment]](/icons/misc/sectionDOWN.gif){kind=icon}
Re: Managing tests - how can we involve the patient?
Managing tests - how can we involve the patient?
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Nancy C. Elder, cincinnati, OH, USA Associate Professor, Family Medicine, University of Cincinnati
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Thank you for your most appropriate comments regarding the important role the patient plays in the testing process. I agree that our study was not set up to address this issue, and that further research is definately needed in this area. We believe that patients are integral to safety and quality, and that primary care practices must find ways to involve patients without abdicating the responsibility that must ultimately lie with the office practice. Patients can be encouraged to serve as "double checkers" for the receipt of results. With shared decision making, patients are involved and educated throughout the testing process, including when the tests are ordered, ("what is the purpose of the test? How will the results affect the care plan? when and how will I get results?") as well as when they are notified of results and follow up is discussed. Appropriate technology and a culture of safety and quality should enhance the role of the patient in this process, but research will be necessary to discover the "appropriate" technology and the aspects of the safety culture that improve patient involvement in the testing process. Competing interests: None declared |
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Milton "Mickey" Eder, Chicago, IL Director of Research, Access Community Health Network
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This study takes a multi-methods approach to exploring the management of test results in primary care offices. The authors identify a lack of standardized processes within offices and failures throughout the results management process as primary sources of patient risk and harm; given the current health care reform debate, we should recognize that these issues also point to laboratory tests as an inefficiently used resource. I am working with Nancy Elder and other researchers on a multi- methods study to examine how a network of community health centers manages the testing and referral process. We also found a lack of standardized office systems and communication/coordination failures at each stage of the testing process as factors that diminish patient safety and increase risks and the potential for patient harm. The current study suggests that offices with effective technology and staff with heightened safety awareness possess a greater likelihood of developing high reliability systems for managing tests. While the effective use of technology can improve communication between the laboratory and the office in the management of specimens and results, it is less clear that heightened safety awareness by staff includes concerns about using technology effectively. It is also not clear if there is a sense of how technology should or can be used to improve communication between staff and patients for patient notification and follow-up on test results. Additional work is welcomed so that we may understand better the potential role technology can play in the way family medicine practices activate patients around tests to reduce risk by fostering increased involvement in their own care. While technology and heightened staff awareness of patient safety occupy key roles in the design of high reliability office test management systems, we also need to add patient activation to the equation. In an environment where primary care offices are increasingly called upon to serve as patient-centered medical homes and to produce improved patient health outcomes, we will all benefit from research that examines patient activation as an additional factor for improving the quality and reliability of office systems. Competing interests: None declared |
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