Effectiveness of point‐of‐care testing for therapeutic control of chronic conditions: results from the PoCT in General Practice Trial

Bubner, Tanya; Laurence, Caroline; Gialamas, Angela; Yelland, Lisa N; Ryan, Philip; Willson, Kristyn; Tideman, Philip; Worley, Paul; Beilby, Justin

doi:10.5694/j.1326-5377.2009.tb02590.x

Cited by 62 publications

(53 citation statements)

References 5 publications

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“…Various POC devices are in common use in the community in Australia and Europe 9. As with other studies, discrepancies in readings were more likely out of the therapeutic ranges, especially when supratherapeutic 10–13.…”

Section: Discussionsupporting

confidence: 50%

Comparison of emergency department point-of-care international normalised ratio (INR) testing with laboratory-based testing

Celenza

Skinner

2010

Emergency Medicine Journal

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Section: Discussionsupporting

confidence: 50%

Comparison of emergency department point-of-care international normalised ratio (INR) testing with laboratory-based testing

Celenza

Skinner

2010

Emergency Medicine Journal

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“…Only one trial found the influence of POC testing on glycaemic control to be the same or better than laboratory testing,[38] was associated with same or better medication adherence[37] increased patient satisfaction in general practice[39] significant cost savings to patients and families[40], but cost-effectiveness was uncertain. [40] The latter outcome is pertinent to our study.…”

Section: Discussionmentioning

confidence: 99%

The impact of a point-of-care testing device on CVD risk assessment completion in New Zealand primary-care practice: A cluster randomised controlled trial and qualitative investigation

et al. 2017

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ObjectivesTo assess the effect of a point of care (POC) device for testing lipids and HbA1c in addition to testing by community laboratory facilities (usual practice) on the completion of cardiovascular disease (CVD) risk assessments in general practice.MethodsWe conducted a pragmatic, cluster randomised controlled trial in 20 New Zealand general practices stratified by size and rurality and randomised to POC device plus usual practice or usual practice alone (controls). Patients aged 35–79 years were eligible if they met national guideline criteria for CVD risk assessment. Data on CVD risk assessments were aggregated using a web-based decision support programme common to each practice. Data entered into the on-line CVD risk assessment form could be saved pending blood test results. The primary outcome was the proportion of completed CVD risk assessments. Qualitative data on practice processes for CVD risk assessment and feasibility of POC testing were collected at the end of the study by interviews and questionnaire. The POC testing was supported by a comprehensive quality assurance programme.ResultsA CVD risk assessment entry was recorded for 7421 patients in 10 POC practices and 6217 patients in 10 control practices; 99.5% of CVD risk assessments had complete data in both groups (adjusted odds ratio 1.02 [95%CI 0.61–1.69]). There were major external influences that affected the trial: including a national performance target for CVD risk assessment and changes to CVD guidelines. All practices had invested in systems and dedicated staff time to identify and follow up patients to completion. However, the POC device was viewed by most as an additional tool rather than as an opportunity to review practice work flow and leverage the immediate test results for patient education and CVD risk management discussions. Shortly after commencement, the trial was halted due to a change in the HbA1c test assay performance. The trial restarted after the manufacturing issue was rectified but this affected the end use of the device.ConclusionsPerformance incentives and external influences were more powerful modifiers of practice behaviours than the POC device in relation to CVD risk assessment completion. The promise of combining risk assessment, communication and management within one consultation was not realised. With shifts in policy focus, the utility of POC devices for patient engagement in CVD preventive care may be demonstrated if fully integrated into the clinical setting.Trial registrationAustralian New Zealand Clinical Trials Registry ACTRN12613000607774

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“…This may have resulted from improved management of patients when PoCT is used as demonstrated in our Trial [9], which may in turn have resulted in reduced hospital visits for patients with diabetes or on anticoagulant therapy. In contrast, hospital admission costs increased for the lipids PoCT group, but again were not statistically significant.…”

Section: Discussionmentioning

confidence: 99%

“…The intermediate outcome indicator used in the cost-effectiveness analysis was the proportion of patients within the therapeutic range for each condition at the end of the Trial [6,9]. The point estimates and confidence intervals for the health outcome indicators are presented in Bubner et al [9].…”

Section: Methodsmentioning

confidence: 99%

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The cost-effectiveness of point of care testing in a general practice setting: results from a randomised controlled trial

Laurence

Moss

Briggs

et al. 2010

BMC Health Serv Res

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BackgroundWhile point of care testing (PoCT) for general practitioners is becoming increasingly popular, few studies have investigated whether it represents value for money. This study aims to assess the relative cost-effectiveness of PoCT in general practice (GP) compared to usual testing practice through a pathology laboratory.MethodsA cost-effectiveness analysis based on a randomized controlled trial with 4,968 patients followed up for 18 months and fifty-three general practices in urban, rural and remote locations across three states in Australia.The incremental costs and health outcomes associated with a clinical strategy of PoCT for INR, HbA1c, lipids, and ACR were compared to those from pathology laboratory testing. Costs were expressed in year 2006 Australian dollars. Non-parametric bootstrapping was used to generate 95% confidence intervals.ResultsThe point estimate of the total direct costs per patient to the health care sector for PoCT was less for ACR than for pathology laboratory testing, but greater for INR, HbA1c and Lipids, although none of these differences was statistically significant. PoCT led to significant cost savings to patients and their families. When uncertainty around the point estimates was taken into account, the incremental cost-effectiveness ratio (ICER) for PoCT was found to be unfavourable for INR, but somewhat favourable for ACR, while substantial uncertainty still surrounds PoCT for HbA1c and Lipids.ConclusionsThe decision whether to fund PoCT will depend on the price society is willing to pay for achievement of the non-standard intermediate outcome indicator.Trial registrationAustralian New Zealand Clinical Trial Registry ACTRN12605000272695

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Effectiveness of point‐of‐care testing for therapeutic control of chronic conditions: results from the PoCT in General Practice Trial

Cited by 62 publications

References 5 publications

Comparison of emergency department point-of-care international normalised ratio (INR) testing with laboratory-based testing

Comparison of emergency department point-of-care international normalised ratio (INR) testing with laboratory-based testing

The impact of a point-of-care testing device on CVD risk assessment completion in New Zealand primary-care practice: A cluster randomised controlled trial and qualitative investigation

The cost-effectiveness of point of care testing in a general practice setting: results from a randomised controlled trial

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