
Special investigations can be used most of the time to confirm the suspected diagnosis.
- A working diagnosis should always be in the pipeline when the clinician moves to order tests; appropriate and relevant tests can be performed.
- Always commence with the cheapest and least invasive. Most of these are available within your primary health clinic. Include baseline tests:
- HIV: CD4, Creatinine, Alanine aminotransferease (ALT), hemoglobin (Hb), serum Cryptococcal Antigen (CrAg)
- Other: syphilis, Hepatitis B, pregnancy test, glucose, cholesterol, urine dipstix® (malaria if indicated or positive travel history), oxygen saturations (pulse oximeter)
- Move onto the more expensive and more invasive if other tests are unhelpful, eg. referral to hospital for a CAT scan, chest X rays, MRI, ultrasound sonar.
- Ensure you have registered with the laboratory to access patient laboratory results. Obtaining results timeously avoids delays and may have important consequences for patients. Accessing results may also be a rate limiting step for patient management. Important future clinical treatment options and clinical decisions may be based upon these results. Delays in obtaining results may carry serious consequences in patients with AHD.
- Repeat blood tests for tracking trends eg. Cr, ALT
- If you plan to up refer the patient to a higher level of care, perform as many tests as you can at the initial clinic and start appropriate management if needed. It is important to send blood/urine cultures before antibiotics are started.
- Saving time obtaining results also reduces patient clinic waiting time. Differentiated models of care result in different models of service delivery. This means stable, well patients need fewer visits which in turn lessens burden of patient visits on HCWs. Patients also benefit by saving time and money on transport costs. The converse is also true. Unstable patients may require more consultation time and more clinic visits.
