There is a vast spectrum of tests for infectious diseases [ID]- sample cultures, sample PCR, PCR of blood and multiple seroloical tests. Today almost all ID testing can be performed in the community- blood samples, swabs for culture and PCR- then performed in community-, hospital- or specialist laboratories. The number of tests available requires a broad knowledge of ID to determine which tests to perform for a specific patient, and which results are prerequisites for advanced testing. There are various ways to improve the relevance of tests sent such as preauthorisation by electronic medical record [EMR] or by email or phone or authorisation after the sample arrives at the testing site. We have been authorising 31 ID tests for over 10 years, determined by cost of test and by overuse. We describe the results of this programme and the relevance for other primary care health systemsIn 2015 we constructed a list of tests which were often found to be nonrelevant. As our EMR is not able to perform preauthorisation, we informed all physicians of the tests included and that a decision whether or not to perform the tests would made after the sample reached the laboratory. This was in order not to increase physician workload and to enable central control at the level of the district laboratory. In all cases of tests not performed, the sending physician was informed by email, together with the reasoning.Over 2021-2024 around 42% of the ID tests sent were approved, with a saving of 60% in costs. Our rate of ID testing was merely a third of the country rate.Costs saved by direct regulation were only a quarter of all savings- the remainder stemmed fron the Hawthorne effect. The regulation required a single ID physician and two part time lab administrative staff. Annual savings amounted to $3 per patient for 500,000 patients.ID testing can be made more focused, saving costs and improving physician capability

In 2024, more than 15 million erythrocyte sedimentation rate (ESR) tests were performed in French primary care, despite the availability of more specific inflammatory markers such as C-reactive protein (CRP). Although ESR has been used in clinical practice for over a century, its diagnostic relevance in general practice remains uncertain.To determine the current, evidence-based indications for ESR testing in adult patients in general practice.A systematic literature review was conducted between March 2020 and January 2022 across PubMed (Medline), Cochrane, Web of Science, Cairn, Lissa, Google Scholar, and La Revue Prescrire. The search combined MeSH terms and related keywords for “erythrocyte sedimentation rate” and “general practice” in English and French. Only studies focusing primarily on ESR testing in adult humans within a clinical context were included. Recent professional guidelines from relevant specialties were also analyzed to contextualize findings.The review identified nine original studies, seven literature reviews or expert opinions, and five clinical practice guidelines. Among them, 81% were published before 2000, highlighting a lack of recent research. Historically, ESR was used as a broad inflammatory screening test, including in asymptomatic patients and cancer screening—indications now considered obsolete. Current evidence supports ESR use only in specific inflammatory conditions: giant cell arteritis (Horton’s disease), rheumatoid arthritis, and Hodgkin lymphoma, often in association with CRP. For other diseases, CRP has replaced ESR due to its faster kinetics, better sensitivity, and higher diagnostic relevance.Despite its declining scientific value, ESR remains widely prescribed in French general practice. Its persistence likely reflects habit, simplicity, low cost, and slow diffusion of updated evidence. There are no formal national recommendations defining ESR use in primary care.The ESR test appears largely obsolete in general practice, except in limited diagnostic contexts (Horton’s disease, rheumatoid arthritis, Hodgkin lymphoma). Physicians should be encouraged to use CRP alone as the preferred inflammatory marker. This work led to recommendations for best practice by the HAS on the use of sedimentation rate.

Diabetes is strongly correlated with heart failure (HF), and early identification of asymptomatic HF (Stage B) can improve outcomes. The American Diabetes Association (ADA) recommends measuring N-terminal pro B-type natriuretic peptide (NT-proBNP) for early diagnosis of HF in people with diabetes. However, achieving universal adoption remains a challenge in clinical practice.A multinational group of primary care, cardiology and endocrinology experts convened to reflect on practical recommendations for implementing the ADA guidelines on a national level. Key parameters for implementation were considered: the patient pathway, resource availability, NT-proBNP thresholds, educational needs of clinicians, and cost implications. The primary finding was the necessity of local tailoring to manage the potential strain on general practitioners and specialist cardiology services. Proposed strategies included: prioritizing high-risk patient phenotypes as the target population (e.g., based on age and existing comorbidities), adopting risk-stratified NT-proBNP thresholds, leveraging digital tools and education led by specialists to enable easier result interpretation and guidance on further actions.The collective experience confirms that a multipronged approach is essential for sustainable early HF detection. Crucially, economic analyses consistently show that NT-proBNP-guided management is cost-effective globally, primarily driven by the reduction in subsequent hospitalizations and downstream complication costs. This evidence of financial benefit is vital for securing local reimbursement. Future practice should utilise digital tools, such as Electronic Medical Records, to automatically select the appropriate patient population for testing, simplify the interpretation of complex, risk-stratified thresholds and facilitate consistent patient monitoring within primary care settings.This collective reflection provides actionable models for general practitioners, supported by cardiologists and endocrinologists, to implement early HF detection programs in their local settings.Effective integration of NT-proBNP testing relies on establishing clear, financially supported, multidisciplinary pathways that balance global guideline directives with national resource capacity and clinical complexity.

HbA1c is widely used to monitor long‑term glycemic control and predict complications in patients with diabetes. However, its reliability is reduced in Chronic Kidney Disease (CKD), where factors such as anemia alter the relationship between glycation and actual glucose exposure. As CKD progresses, HbA1c levels may be falsely decreased, weakening their correlation with fasting glucose. Because clinical guidelines often rely on specific HbA1c thresholds, these inaccuracies may contribute to suboptimal medication management, treatment delays, and increased risk of complications.To characterize how the correlation between fasting plasma glucose and HbA1c changes across CKD stages in patients with and without anemia.We conducted a cross‑sectional study using medical records from a large health maintenance organization, including all adults with type 2 diabetes. CKD stage was defined by estimated glomerular filtration rate (eGFR). Anemia was defined as hemoglobin <12 g/dL in women and <13 g/dL in men. Linear regression models and Pearson correlation coefficients were used to assess the relationship between fasting glucose and HbA1c across CKD stages, stratified by anemia status.The study included 69,200 adults with diabetes, of whom 18.0% had eGFR <60 mL/min/1.73m². Among patients with eGFR ≥60 and no anemia, HbA1c increased by 0.023 percentage points for each 1 mg/dL increase in fasting glucose. This slope decreased to 0.020 for those with eGFR 45–59 without anemia, 0.018 for those with anemia, and 0.011 for patients with eGFR <15. Correlation between fasting glucose and HbA1c was high in patients with eGFR ≥60 (R=0.71, CI 0.70–0.71) and declined with worsening CKD and anemia: R=0.64 (CI 0.62–0.65) and R=0.57 (CI 0.24–0.60) for eGFR 45–59 without and with anemia, respectively, and R=0.54 (CI 0.47–0.61) for eGFR <15.The relationship between fasting glucose and HbA1c weakens progressively with declining kidney function, particularly in the presence of anemia. These findings reflect physiological changes in CKD, including shortened red‑cell lifespan, that contribute to falsely low HbA1c values.HbA1c is less reliable as kidney function declines, and anemia further reduces its accuracy. Clinicians should interpret HbA1c cautiously in CKD and consider complementary markers to avoid undertreatment and prevent complications.

Managing diabetes solely through blood glucose levels is insufficient to reduce morbidity and mortality caused by the disease. The Mexican Social Security Institute (IMSS) has 5.3 million people diagnosed with diabetes, and for years, Glycosylated hemoglobin (HbA1c) testing was not available at the primary care level. In recent years, the use of HbA1c has been promoted as part of the assessment of glycemic control in people living with diabetes.In 2024, the IMSS conducted a pilot program to increase the use of Glycosylated hemoglobin testing at the primary care level. This program was implemented in 35 Family Medicine Units across three Mexican states (Coahuila, Jalisco, and Veracruz), which lack nearby access to laboratories. These units were provided with point-of-care equipment and cartridges for rapid HbA1c testing. Field visits were conducted (January-March), and training was provided to healthcare team personnel.Laboratory tests are necessary for all individuals to accurately assess patients' metabolic control. Plans are underway to make portable equipment for rapid glycated hemoglobin testing available to healthcare providers and patients.Having rapid glycosylated hemoglobin tests would be beneficial for clinical decision-making to improve the management of diabetes in people living with the disease, specially en family medicine units far away or without laboratoryGiven the lack of access to laboratory services and HbA1c testing in Family Medicine Units (UMF), having a point-of-care device for rapid HbA1c determination can facilitate therapeutic adjustments by physicians to improve diabetes control.

The low-dose dexamethasone suppression test (DST) is widely used in primary care for screening endogenous Cushing’s syndrome, yet interpretation in daily practice remains challenging. Acute illness, metabolic disturbances, and individual hypothalamic–pituitary–adrenal (HPA) variability may generate borderline or inconsistent cortisol levels, complicating clinical decision-making regarding further evaluation.A 71-year-old woman with poorly controlled type 2 DM was hospitalized for urinary tract infection. Laboratory tests revealed markedly elevated ACTH (125 pg/mL) and cortisol (60 µg/dL) despite the absence of cushingoid appearance on physical examination. An in-hospital overnight low-dose DST showed absent suppression (33.2 µg/dL), and pituitary MRI revealed normal size without focal lesion. After clinical stabilization, a repeated DST demonstrated equivocal suppression (1.92 µg/dL). During follow-up, her metabolic profile remained variable, but no clear evidence of overt hypercortisolism emerged.DST should ideally be performed when the clinical condition has stabilized to avoid misleading results. The equivocal suppression after recovery shows that abnormal findings obtained during acute illness might require confirmation rather than immediate interpretation. Furthermore, when results remain abnormal or equivocal, complementary tests—such as 24-hour urinary free cortisol or late-night salivary cortisol—can help clarify the biochemical picture. Applying a stepwise diagnostic sequence based on pre-test probability can help avoid unnecessary advanced imaging and guide more appropriate follow-up.Equivocal DST results can create uncertainty in routine practice, especially when laboratory values are not clearly interpretable or change over time. Using longitudinal assessment and focused follow-up testing can help clinicians better understand these borderline findings and avoid unnecessary escalation of care.A structured, context-based approach supports more reliable interpretation of DST results and promotes more efficient use of healthcare resources in primary care.

Inappropriate antibiotic prescribing for mild acute respiratory infections (ARIs) contributes to bacterial resistance. In Primary Care, clinical assessment alone often does not allow clinicians to differentiate reliably between viral and bacterial infections. C-reactive protein (CRP) point-of-care testing (POCT) provides rapid capillary blood analysis (under 10 minutes) and may support more accurate decision-making. The main public Primary Care provider in Catalonia implemented CRP POCT across selected adult and paediatric centres to improve ARI management.A multidisciplinary steering group was established to plan the implementation and anticipate operational challenges. The strategy accounted for the seasonal increase in ARIs, aiming to guarantee full functionality before late autumn. Key actions included procurement of 110 CRP POCT devices, identification of territorial leads to support rollout, development of clinical algorithms incorporating CRP measurement when diagnostic uncertainty exists, distribution of devices to pilot centres, and structured training for local leads and healthcare teams. Following deployment, pilot centres began routine use of CRP POCT, with a final evaluation phase planned.Successful implementation required close collaboration across clinical, managerial and technical teams, highlighting the importance of structured change-management strategies. CRP POCT has the potential to enhance diagnostic accuracy, guide antibiotic prescribing, and support communication with patients about the appropriateness of antibiotics. Evaluation expected in early 2026 will examine utilisation indicators, appropriateness of testing, and antibiotic-prescribing patterns, informing whether expansion to all Primary Care teams is warranted.Early implementation suggests that structured planning, territorial leadership and clear clinical pathways are essential for integrating POCT technologies into routine Primary Care workflows.This project may become an effective and scalable model for improving ARI management, promoting rational antibiotic use, and strengthening resolution capacity in Primary Care.