{
  "abstract": "Monitoring long-term conditions (LTCs), including hypertension, type 2 diabetes mellitus (T2DM), and chronic kidney disease (CKD), is heavily reliant on blood testing. In England, an estimated 13.8 million people live with hypertension, 6.5 million with T2DM, and 4.1 million with CKD, with significant overlap among these conditions. Despite the importance of monitoring these LTCs, current guidelines for blood test selection and frequency lack robust, evidence-based guidance and rely primarily on expert opinion. This has resulted in substantial variability in testing, potentially leading to unnecessary tests, overdiagnosis, and increased burden on healthcare providers. Incidental abnormalities in blood tests can lead to follow-up investigations and treatments that provide little or no clinical benefit to patients. Primary care pathology services cost the NHS £1.8 billion annually and significantly contribute to general practitioners’ (GPs) workload, with GPs spending an estimated 1.5 to 2 hours each day reviewing test results.The ‘Test Smart’ study aims to address these issues by implementing evidence-based blood testing panels for hypertension, T2DM, and CKD. The panels were developed based on the best available evidence and expert consensus to prioritise clinically actionable results while avoiding unnecessary investigations. Additionally, patient-facing resources have been co-designed using the person-based approach to enhance understanding of test results and improve engagement in disease management. The intervention aims to reduce unnecessary testing, improve patient engagement with monitoring tests, minimise overdiagnosis, and optimise resource allocation within primary care.The ‘Test Smart’ study is a pragmatic two-arm cluster randomised controlled trial (cRCT) across 20 general practices in two Integrated Care Boards (ICBs). Ten practices will implement the Test Smart intervention, and ten will continue usual care. All practices will undergo a one-month run-in phase followed by 12 months of data collection. The ‘Test Smart’ trial is scheduled to run from Q1 2025 to Q3 2026, with 12 months of data collection at each practice. Primary outcomes include changes in blood testing rates and patient activation, defined as the ability and confidence to manage one’s health. Secondary outcomes include hospitalisation rates, patient satisfaction, comprehension of test results, and the cost-effectiveness of the intervention.With over 15 million individuals in England affected by LTCs, this study addresses the need to optimise testing strategies, ensuring clinical necessity while reducing the risks and burdens associated with overdiagnosis. By aligning testing practices with robust evidence, the Test Smart study has the potential to improve the efficiency of LTC monitoring, reduce GP workload, and achieve cost savings for healthcare providers. We will present the study rationale and design, outlining the approach taken to evaluate evidence-based blood testing panels in primary care. We will also discuss insights learned from the trial so far.",
  "authors": [
    {
      "affiliations": [
        "University of Bristol, Bristol, UK"
      ],
      "name": "Jonathan Decker"
    },
    {
      "affiliations": [
        "University of Bristol, Bristol, UK"
      ],
      "name": "Martha Elwenspoek"
    },
    {
      "affiliations": [
        "University of Bristol, Bristol, UK"
      ],
      "name": "Tracey Stone"
    },
    {
      "affiliations": [
        "University of Bristol, Bristol, UK"
      ],
      "name": "Katie Charlwood"
    },
    {
      "affiliations": [
        "University of Bristol, Bristol, UK"
      ],
      "name": "Isobel Lindsay-Wiles"
    },
    {
      "affiliations": [
        "University of Bristol, Bristol, UK"
      ],
      "name": "Alastair Hay"
    },
    {
      "affiliations": [
        "University of Bristol, Bristol, UK"
      ],
      "name": "William Hollingworth"
    },
    {
      "affiliations": [
        "University of Bristol, Bristol, UK"
      ],
      "name": "Jonathan Banks"
    },
    {
      "affiliations": [
        "University of Bristol, Bristol, UK"
      ],
      "name": "Pete Blair"
    },
    {
      "affiliations": [
        "University of Bristol, Bristol, UK"
      ],
      "name": "Christina Stokes"
    },
    {
      "affiliations": [
        "University of Bristol, Bristol, UK"
      ],
      "name": "Francesco Palma"
    },
    {
      "affiliations": [
        "University of Bristol, Bristol, UK"
      ],
      "name": "Jessica Watson"
    },
    {
      "affiliations": [
        "University of Bristol, Bristol, UK"
      ],
      "name": "Penny Whiting"
    }
  ],
  "title": "055 The ‘test smart’ trial: evidence-based blood testing for long-term conditions",
  "uid": "74b6384b-425b-5ab6-bf43-4e79ef570711"
}