IMPACT OF INTRODUCING NEAR PATIENT TESTING FOR STANDARD INVESTIGATIONS IN GENERAL-PRACTICE

Objective-To assess the clinical and economic impact of surgery based near patient testing in general practice for six commonly used biochem ical and bacteriological tests. Design-After four months' monitoring, equipment for two bacteriological and four biochemical tests was intro duced without cost into 12 practices using a crossover design. Structu red request forms were used to monitor laboratory investigations. Sett ing-12 general practices in west midlands and south west Thames with l ist sizes above 9000. Main outcome measures-Investigation rates per 10 00 consultations. Changes from baseline rates. Reasons for requesting investigations and provisional diagnoses. Cost per test and sensitivit y of costs to rate of use. Results-Investigation rates for the six tes ts rose by 16.5% (from 78.6/1000 consultations to 91.6/1000) when equi pment was available in the surgery and reverted to baseline rates when it was withdrawn. The average weekly number of tests when equipment w as available ranged from 0.5 to 10.5 (mean 9.0). Cholesterol tests wer e used as an addition to laboratory testing, usually for screening. Mi dstream urine analysis was often done in the surgery instead of in the laboratory, although 30% of samples were tested by both methods. Doct ors' reasons for investigation and conditions tested were largely unaf fected by availability of surgery tests. Costs for surgery tests were higher for all tests except midstream urine. Conclusions-Availability of surgery based testing increased the number of tests performed. It w as cost effective only for midstream urine analysis.