Introduction Laboratory comments appended on clinical biochemistry reports are common in the UK. Although popular with clinicians and the public, there is little evidence that these comments influence the clinical management of patients. Methods We provided reflex automated laboratory comments on all primary care lipid results including, if appropriate, recommendation of direct referral to the West Midlands Familial Hypercholesterolaemia service (WMFHS). Over a two-year period, the number GP referrals from the Wolverhampton City Clinical Commissioning Group (CCG) to the WMFHS were compared with four comparator CCGs of similar population size, who were not provided with reflex laboratory comments. Results Over the study period, the WMFHS received more referrals from Wolverhampton GPs (241) than any other comparator CCG (range 8–65) and greater than the combined referrals (172) from all four comparator CCGs. Conclusion Targeted reflex laboratory comments may influence the clinical management of patients and may have a role in the identification of individuals with familial hypercholesterolaemia.

Primary care physicians are responsible for the initiation of the preventive health screening tests and examinations for their patients. Resident physicians may be uncomfortable obtaining a sexual history from their patient. A performance improvement project was carried out in the resident clinic to see if we could improve HIV screening of our patients. With a cohesive effort between the faculty preceptors and residents, we were able to improve screening rates for HIV and improve some aspects, but not all, of sexual history taking for our population of patients. We identified two patients who screened positive for a rate of 1.4%.