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Year : 2020  |  Volume : 14  |  Issue : 2  |  Page : 63-67

Direct access versus physician's pre-authorized laboratory testing: The experience at a clinical laboratory in South-South, Nigeria

1 Department of Haematology and Blood Transfusion, Federal Medical Centre, Yenagoa, Bayelsa State, Nigeria
2 Department of Anatomical Pathology, Federal Medical Centre, Yenagoa, Bayelsa State, Nigeria

Correspondence Address:
Esther Ifeoma Obi
Department of Haematology and Blood Transfusion, Federal Medical Centre, Yenagoa, Bayelsa State
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/phmj.phmj_27_19

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Background: The traditional health-care model in this country places the physician (or appropriate ordering provider) in control of determining what diagnostic and therapeutic monitoring (including laboratory tests) is to be performed on a patient. A paradigm shift in the way medical care is provided has been observed; with a change in the delivery of health-care moving from physicians into the hands of the patients. One manifestation of this has been direct access testing (DAT) for laboratory services defined as patient (as opposed to physician) initiated testing of human specimens. Appropriateness of tests ordered and reliable interpretation of test results are some of the concerns associated with DAT. Aim: To determine the comparative evaluation of DAT compared to physicians' pre-authorised laboratory testing at a clinical laboratory. Methods: All laboratory requisition orders made to the Pathology Department at Bayelsa Diagnostic Centre, Yenagoa, Bayelsa State within a 2-year period were evaluated. Results: A total of 15,755 requisition orders were analysed. The prevalence of DAT was 21.2% compared to 78.8% of physicians pre-authorised laboratory tests. Nine out of the ten most frequently ordered investigations: full blood count, electrolyte, urea and creatinine, microscopy, culture and sensitivity, microscopic diagnosis of malaria parasite, (urinalysis, Widal test, lipid profile, liver function test and erythrocyte sedimentation rate were pre-dominantly physicians' pre-authorised requisition orders. Fasting blood glucose was the only investigation that had a higher prevalence from DAT. More than half (1753 [52.5%]) of the self-referred patients did not present with clinical history while majority (10,087 [81.2%]) with laboratory tests pre-authorised by physicians presented with clinical details. Conclusion: This study highlights that laboratory test pre-authorised by physicians still remains the traditional healthcare model in South-south Nigeria.

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