Laboratory medicine in primary health care.

A LTHOUGH simple laboratory tests have been performed At'1.in primary health care for many years, recent technological developments have made it possible to do a much wider range of tests nearer the patient ('near patient testing').'-3 Many of these tests require little equipment and a non-technical person such as a nurse can often obtain a result within a few minutes. In the United States at least 20% of all laboratory tests are now done in doctors' offices.4 The proportion is probably smaller in most European countries, but the growing importance of primary care, together with economic and social factors, will inevitably lead to an increase. There are also a few tests which can be done by the patient. Some of these can be purchased 'over the counter, but others (such as blood glucose meters used by diabetics) are becoming important for patient management. At the same time the use of the hospital laboratory by general practitioners is being influenced by new methods of communication technology, such as computer linkages which allow rapid transmission of results and two-way access to information. At a time of rapid change, a recent conference report' provides a salutary reminder that both laboratories and doctors in primary care will need to modify their methods of working to make the best use of these new opportunities and avoid some of the pitfalls. Access to laboratory tests is no longer a major problem: the fundamental question is not whether it is possible to do the test, but whether it is worth doing and, if so, where it should be done and who will pay for it. As in all branches of medicine, the need for cost-effectiveness is paramount. At present the requirements for laboratory medicine in primary health care are ill-defined, but they differ in many respects from those of hospital medicine. The nature of the clinical problem, the prevalence of disease, and the need for urgent testing are different. In primary care there are increasing demands for laboratory tests in occupational health, preventive medicine and health educational programmes. There are wide variations in the numbers and types of laboratory tests requested by general practitioners.6 The reasons for these differences , and their impact on patient care, need investigation. More data are needed to provide a baseline for assessing the effect of introducing new technologies and working practices. Advantages and disadvantages of near patient testing Some of these …