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. 2012 Oct 30;1(1):8.
doi: 10.4102/ajlm.v1i1.8. eCollection 2012.

Laboratory testing improves diagnosis and treatment outcomes in primary health care facilities

Jane Y Carter  1 , Orgenes E Lema  1 , Magdaline W Wangai  1 , Charles G Munafu  2 , Philip H Rees  3 , Jackson A Nyamongo  4
Affiliations

Laboratory testing improves diagnosis and treatment outcomes in primary health care facilities

Jane Y Carter et al. Afr J Lab Med. .

Abstract

Objective: To determine if use of basic laboratory tests improves diagnosis and treatment outcomes in outpatients attending rural primary health care facilities.

Setting: Six rural health centres in Kenya.

Design: Cross-sectional study to observe change in diagnosis and treatment made by clinical officers after laboratory testing in outpatients attending six rural health centres in Kenya.

Subject: The diagnosis and treatment of 1134 patients attending outpatient services in six rural health centres were compared before and after basic laboratory testing. Essential clinical diagnostic equipment and laboratory tests were established at each health centre. Clinical officers and laboratory technicians received on-site refresher training in good diagnostic practices and laboratory procedures before the study began.

Results: Laboratory tests were ordered on 704 (62.1%) patients. Diagnosis and treatment were changed in 45% of tested patients who returned with laboratory results (21% of all patients attending the clinics). 166 (23.5%) patients did not return to the clinician for a final diagnosis and management decision after laboratory testing. Blood slide examination for malaria parasites, wet preparations, urine microscopy and stool microscopy resulted in most changes to diagnosis. There was no significant change in drug costs after laboratory testing. The greatest changes in numbers of recorded diseases following laboratory testing was for intestinal worms (53%) and malaria (21%).

Conclusion: Effective use of basic laboratory tests at primary health care level significantly improves diagnosis and patient treatment. Use of laboratory testing can be readily incorporated into routine clinical practice. On-site refresher training is an effective means of improving the quality of patient care and communication between clinical and laboratory staff.

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Conflict of interest statement

The authors declare that they have no financial or personal relationship(s) which may have inappropriately influenced them in writing this paper.

Figures

FIGURE 1
FIGURE 1
Ten most common diagnoses in all health centres.
FIGURE 2
FIGURE 2
Number of drug courses prescribed and costs before and after laboratory testing.
See this image and copyright information in PMC

References

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    1. Lema OE, Carter JY, Wangai MW, Rees PH, Nyamongo JA. Key indicators can measure improved laboratory utilisation after interventions to strengthen diagnostic services in primary health care. In prep.

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