November 28, 2011
More Research Needed To Understand Impact Of Direct Patient Access To Test Results
A recent initiative proposes to allow patients to obtain access to their test results directly from a laboratory. But, according to researchers at Baylor College of Medicine, the impact of patients having direct access to test results without physician interpretation in the picture is unclear. They are advocating for more research to guide best practices in this area.
Their report considers impacts from both the physician and patient perspectives. The report was released online today in the Journal of the American Medical Association.
"Many people have said that the solution to improve follow-up of test results is giving the test results directly to patients," said Dr. Hardeep Singh, assistant professor of medicine and health services research at the Veterans Affairs Health Services Research and Development Center of Excellence and BCM, and senior author of the report. "However, the current state of the science tells us two sides of the story: one from the physician and the other from the patient."
There is not enough evidence available to conclude whether providing potentially immediate direct access to lab results will have a positive or negative impact on patients and physicians, according to Singh, who is also with the Michael E. DeBakey Veterans Affairs Medical Center.
The perspective from the physicians is that they may be uncomfortable with release of abnormal test results directly to patients. This is because the traditional model includes physician interpretation of the abnormality followed by an information exchange between the physician and the patient about the context of the test results. Physicians might also be concerned that patients would become anxious about the abnormalities and have questions for the physician who may or may not have the test results yet.
"We also don´t know what the impact will be on patients receiving sensitive reports such as pathology and HIV directly from the lab rather than from someone who is trained to convey this information," said Traber Giardina, also with the VA Medical Center and a Ph.D. student at the University of Houston, who was the first author of the paper.
Because of the need for transparency in health care reform, researchers understand the need for patients to have direct access to test results and they also recognize that patients want direct access to results.
"Although direct access may empower patients to actively follow-up with physicians, this might not always occur, possibly because of lack of clarity or confusion about who is responsible for the next step," said Giardina.
"We need to be balanced and think of both intended and unintended consequences that might result," said Singh. "At this time, we do not have all the answers about what the best practices might be. The scientific knowledge needed to develop these best practices is still evolving."
Singh and Giardina recommend more research be conducted to evaluate the impact of direct access on patients and physicians and to guide the development and implementation of best practices in this area.
The investigators are funded by the VA National Center of Patient Safety, Agency for Health Care Research and Quality, a SHARP contract from the Office of the National Coordinator for Health Information Technology and the Houston VA Health Services Research and Development Center of Excellence.