Millions of people with high blood pressure, type 2 diabetes, or chronic kidney disease currently get blood tests at intervals chosen largely by habit or guesswork. This five-year programme will replace that uncertainty with hard evidence on which tests to run and how often. The problem is stark: no robust guidelines exist for monitoring these common long-term conditions in GP surgeries. Clinicians order tests without knowing whether they are too frequent (wasting NHS resources and inconveniencing patients) or too rare (missing early signs of deterioration). The researchers will combine rapid literature reviews, analysis of millions of anonymised patient records from GP databases, cost-effectiveness modelling, and interviews with patients who skip monitoring appointments. They will then test their evidence-based strategy against current practice in a cluster randomised trial across 190 GP practices. If successful, the new testing strategies—delivered through electronic test-ordering systems already used in surgeries—could reduce unnecessary appointments, catch complications earlier, and free up NHS funds for other care. The team will also produce plain-language materials for patients and clinicians to help put the findings into routine use.
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BACKGROUND Most patients with long term conditions (LTC) are managed in primary care; regular blood tests assess disease progression, treatment response, complications, and associated diseases. There is no robust evidence to inform recommendations on selection of tests, or test frequency for people with LTC. AIMS AND OBJECTIVES To optimise testing to monitor LTC (hypertension, T2DM and CKD) in primary care by developing evidence-based testing strategies (EBTS) and accompanying patient and clinician materials. METHODS WP 1: Develop evidence-based testing panels for people with LTC: Rapid reviews and clinical practice research datalink (CPRD) analysis to develop evidence-based recommendations on which tests people with LTC should have to monitor their condition. A consensus meeting of advisory panel members of will select tests for inclusion, exclusion or further analysis. WP 2: Develop evidence-based recommendations on frequency of monitoring Combination of rapid review methods, CPRD analysis and cost-effectiveness modelling using a linked evidence approach to determine optimal testing panels and frequency. Value of information analysis to assess value of further research. WP 3: Explore patient, clinician and commissioner views on testing to monitor people with LTC Following the person-based approach (PBA) to developing and implementing interventions, we will use qualitative interviews to understand patient, clinician and commissioner views on testing. We will interview patients with LTC who do not regularly attend for monitoring to understand barriers to engagement. WP 4: Produce information materials for patients and clinicians to facilitate implementation Development of an intervention package, including patient and clinician resources, to support implementation of the new testing strategy at a practice level. WP 5: Clinical and cost-effectiveness of EBTS to monitor LTC with current practice: efficient design cluster randomised controlled trial (CRCT) We will use a CRCT with randomisation at the GP practice level to compare our EBTS to standard care. Initial feasibility work will assess whether: EBTS developed is sufficiently different to routine care; sufficient CCGs and GP practices consent to take part; EBTS implementable at GP practice level; outcomes fully defined and collectable from routine data. A report describing progress on the programme, with particular emphasis on the feasibility work, together with the protocol will be sent to NIHR for approval at 30 months. The full trial will be carried out in 190 GP practices with outcome data collected via CPRD. The EBTS will be implemented through electronic test ordering systems. TIMELINES FOR DELIVERY 5 years from 1 January 2021. Key milestones: WP1 (June 2021-May 2023); WP2 (December 2022-May 2024); WP3 (December 2021-May 2023); WP4 (June 2023-May 2024); WP5 feasibility (June 2022-May 2024); finalise progression criteria (31/5/2023); interim report to NIHR (30/11/2023); WP5 CRTC (June 2024-May 2026); report production (June 2025-May 2026). ANTICIPATED IMPACT AND DISSEMINATION This programme of work has the potential to change how LTCs are monitored in primary care, ultimately improving patient outcomes and leading to more efficient use of NHS resources. Results will be reported in peer-reviewed journals, academic and public presentations and social media. We will discuss findings with patient groups to help with dissemination to patients.
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