Pre-visit labs?

[SCPA]

Curious how others are managing lab work for chronic conditions. Pre-visit labs vs labs the day of appointment. New to practice here. I get better compliance when ordering labs the same day as pts appointment, but find it difficult to make adjustments when needed.. call backs, explaining changes to pts over the phone, having pts return before their next scheduled appointment to make changes, etc..  becomes a real hassle as patient load increases. At the same time, waiting until their next appointment 3-6 months or more to go over labs and make med changes seems ineffective. Are pre-visit labs the way to go? 

[AliB]

note:  I am not a practicing PA; I start my program in May.  I have a family member with a chronic condition.  His IM PA schedules his patients for labs one week before each quarterly visit.  I was already aware of this based on my family member's care, but I also know it's this PA's standard practice from my experience shadowing him.  

[Randito]

I work in IM specialty, but we ask all pts to complete labs 1-2 weeks prior to follow ups. Depending on the interval between appointments, we may get labs right after one appointment (especially to aid in diagnosis) then again 2, 3, 6 months later, prior to the next follow up.

[rev ronin]

I work in IM specialty, but we ask all pts to complete labs 1-2 weeks prior to follow ups. Depending on the interval between appointments, we may get labs right after one appointment (especially to aid in diagnosis) then again 2, 3, 6 months later, prior to the next follow up.

This.  Diagnostic labs happen after the visit (or during, if the patient and I agree waiting for stat labs is appropriate), monitoring labs happen before the follow-up visit, and check-to-see-if-the-elevated-number-self-corrects labs happen a week or two after the initial visit.

[ventana]

have done both ways

 

ordering during the visit allows the visit to go faster - but they you have call backs and if there is a clinical change you are doing it over the phone (sometimes easier, sometimes harder)

 

have done before allows you to review with the patient, and make changes in visit, has liability of finding something way off and needing urgent management prior to seeing them, or them no showing for their appointment and then you have to get them in.

 

Overall I do both, no one right way.

[Guest Paula]

I hated pre-visit labs.  As the new practitioner to my current practice 3 years ago the standard was pre-visit labs and they were all determined by a list the MD had.  I did not agree with the list as the MD still ordered UAs for everybody, and then would treat asymptomatic bacteriuria, PSAs for all men past 40 plus there was no consideration for those who needed labs not on the list such as a TSH.  So I changed to labs after the visit, and even stopped ordering fasting coronary risk panels so my non-fasting patients could get their labs.  Keep in mind I work (for 2 more weeks) at a FQHC and I would get the labs when the patient was in my grips and base it on what was needed.

 

I try not to order spurious labs.  It will probably depend on the type of practice you are in.

 

I start my new job the end of Feb and will learn how the FP/IM group handles this issues. 

[taotaox1]

For me, new patients never get pre visit labs. However, for established patients i almost always order pre vist labs at their annual, for their next annual. I know what they need at that point so i can still be selective about ordering, but dont have to follow up with all my patients on the phone. The same goes for various workup scenarios. I hate doing big changes over the phone.