Evaluation of Laboratory Diagnostics in Service of Primary Health Care

Introduction: Primary health care cannot be imagined without appropriate laboratory diagnosis. Often, situations arise when many laboratory tests are done without a real need. The aim of this paper is to show how many requests by different doctors in primary care are referred to laboratories, and whether there are possibilities of rationalizing the number of tests. Material and Methods: The sample consisted of 1000 male and female patients from different age groups. All of them were users of primary health care in hematology-biochemical laboratory of the Primary Health Care Center Gracanica (Tuzla Canton), who have on various grounds verified illness by a competent physician and referred to medical-biochemical laboratory. Results: There were 636 female respondents and 364 male. From the baseline of 5333 of tests 2348 tests or 44% are requested by general practitioners. Family Medicine doctors were asking for 2167 tests or 40, 7% and other specialists required 818 tests or 15, 3%. Percentage of individual laboratory tests requested by all the teams of doctors involved in the health care system was in this order: glucose (14%), whole blood test (14%), urine (13.9%), sedimentation (10.3%), total cholesterol (8.5%), triglycerides (8.4%), aminotransferase (ALT, AST 6.7%), creatinine (6.7%), urea (4.8%), bilirubin (0.9%), fibrinogen (0.9%), CRP (0.8%), AF (0.8%), HDL cholesterol (0.7%), serum calcium (0.6%), phosphorus in serum (0.5%), acidum uricum (0.5%). Discussion and conclusions: Percentage of the most common test for the leading diseases in family practice at the Primary health care Center showed lack of selectivity. Some tests were much more requested by general practitioners than family medicine specialists, e.g. urine, whole blood, glucose in respiratory diseases. Family doctors a lot more referred patients for lipid status than general practitioners in urinary diseases. The presence of the metabolic syndrome significantly increases the number of tests.