Background Studies have shown unwarranted variation in test ordering among GP practices and regions, which may lead to patient harm and increased health care costs. There is currently no robust evidence base to inform guidelines on monitoring long-term conditions. Objectives To map the extent and nature of research that provides evidence on the use of laboratory tests to monitor long-term conditions in primary care, and to identify gaps in existing research. Methods We performed a scoping review—a relatively new approach for mapping research evidence across broad topics—using data abstraction forms and charting data according to a scoping framework. We searched CINAHL, EMBASE and MEDLINE to April 2019. We included studies that aimed to optimize the use of laboratory tests and determine costs, patient harm or variation related to testing in a primary care population with long-term conditions. Results Ninety-four studies were included. Forty percent aimed to describe variation in test ordering and 36% to investigate test performance. Renal function tests (35%), HbA1c (23%) and lipids (17%) were the most studied laboratory tests. Most studies applied a cohort design using routinely collected health care data (49%). We found gaps in research on strategies to optimize test use to improve patient outcomes, optimal testing intervals and patient harms caused by over-testing. Conclusions Future research needs to address these gaps in evidence. High-level evidence is missing, i.e. randomized controlled trials comparing one monitoring strategy to another or quasi-experimental designs such as interrupted time series analysis if trials are not feasible.

Background We have shown previously that current recommendations in UK guidelines for monitoring long-term conditions are largely based on expert opinion. Due to a lack of robust evidence on optimal monitoring strategies and testing intervals, the guidelines are unclear and incomplete. This uncertainty may underly variation in testing that has been observed across the UK between GP practices and regions. Methods Our objective was to audit current testing practices of GPs in the UK; in particular, perspectives on laboratory tests for monitoring long-term conditions, the workload, and how confident GPs are in ordering and interpreting these tests. We designed an online survey consisting of multiple-choice and open-ended questions that was promoted on social media and in newsletters targeting GPs practicing in UK. The survey was live between October–November 2019. The results were analysed using a mixed-methods approach. Results The survey was completed by 550 GPs, of whom 69% had more than 10 years of experience. The majority spent more than 30 min per day on testing (78%), but only half of the respondents felt confident in dealing with abnormal results (53%). There was a high level of disagreement for whether liver function tests and full blood counts should be done ‘routinely’, ‘sometimes’, or ‘never’ in patients with a certain long-term condition. The free text comments revealed three common themes: (1) pressures that promote over-testing, i.e. guidelines or protocols, workload from secondary care, fear of missing something, patient expectations; (2) negative consequences of over-testing, i.e. increased workload and patient harm; and (3) uncertainties due to lack of evidence and unclear guidelines. Conclusion These results confirm the variation that has been observed in test ordering data. The results also show that most GPs spent a significant part of their day ordering and interpreting monitoring tests. The lack of confidence in knowing how to act on abnormal test results underlines the urgent need for robust evidence on optimal testing and the development of clear and unambiguous testing recommendations. Uncertainties surrounding optimal testing has resulted in an over-use of tests, which leads to a waste of resources, increased GP workload and potential patient harm.

BackgroundMore than half of tests ordered by GP practices are to monitor long-term conditions such as high blood pressure, diabetes, and chronic kidney disease (CKD). There is a large variation in ordered tests between GP practices, suggesting some tests may not be appropriate. Unnecessary testing should be avoided as it can generate anxiety for patients, increase workload for doctors, and increase costs for the health service.AimThe objective was to review monitoring strategies for hypertension, type 2 diabetes, and CKD patients and to investigate the evidence-base underlying these recommendations.MethodCurrent UK guidelines on the relevant diseases were reviewed. Any guidance on the use of laboratory tests for disease monitoring (not including drug monitoring recommendations), the recommended frequency of testing, as well as the level of evidence on which the guidance was based was extracted.ResultsGuidelines for the use of monitoring tests in primary care for hypertension, diabetes, and CKD are unclear and incomplete; for example, recommended frequency of testing varied between guidelines or was not specified at all. Current recommendations for monitoring chronic diseases are largely based on expert opinion; robust evidence for optimal monitoring strategies and testing intervals is lacking.ConclusionIn the absence of clear evidence, clinicians should consider which tests are likely to influence patient management and should ensure that there is a clear clinical rationale for each test that they perform. Future research should address what the optimal strategy for monitoring chronic conditions consists of, and how it can be evaluated.

The term ‘Priming and Lagging’ has been defined in two different ways.The Admiralty Manual of Navigation (1922) defines it as occurring when the resultant of the solar and lunar tides arrives before or after the lunar tide would arrive. This is here called definition A. The Admiralty Manual of Tides (1941) defines it as occurring when the interval between successive diurnal high waters is less or more than the average 24h 50m. This is here called definition B.