Methodology to create evidence-based testing panels for monitoring long-term conditions in primary care

Résumé fourni par la source

Background Patients with long term conditions (LTC) have regular monitoring appointments including blood tests. These tests aim to monitor disease progression, treatment response, and detection of complications. The evidence base for current testing recommendations is weak because measuring patient benefits or harms of regular monitoring is challenging and are dependent on what is done in response to the test result. Objectives To develop a methodology for creating evidence-based testing strategies to monitor people with LTCs. Methods We identified a list of commonly used blood tests. We defined a series of filtering questions to determine whether there was evidence to support the rational of monitoring, such as ‘can the GP do anything in response to an abnormal test result?’. Through a series of rapid reviews we identified evidence to answer each question. At consensus meetings clinicians and patients voted on each test for inclusion, exclusion, or further evidence needed. A process evaluation was performed alongside this. Additional evidence was collected by performing further rapid reviews and by analysing routinely collected healthcare data, including incidence analyses and emulating RCTs. Results We tested this methodology on three common LTCs chronic kidney disease (CKD), type 2 diabetes mellitus (T2DM), and hypertension. We identified 18-21 commonly used tests per condition. We found that for the majority of blood tests the evidence-base was weak or absent. Only 1-2 tests per condition could be included (e.g. HbA1c and eGFR for monitoring T2DM patients) and 8-13 tests could be excluded (e.g. inflammation markers for all three conditions) based on evidence alone. The consensus group selected 4-8 tests per condition where additional evidence was needed to make a decision. The new evidence was generally weak and a final consensus meeting was necessary to finalise the testing panels based on expert opinion. Conclusions We are currently testing the clinical and cost-effectiveness of the developed testing panels in a cluster RCT. This methodology may be used to optimise disease monitoring of other chronic conditions. Implementing evidence-based testing panels may address some of the unwarranted variation in testing and improving patient outcomes by reducing patient harm related to over- and undertesting.

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