Impact of point-of-care panel tests in ambulatory care: a systematic review and meta-analysis

Abstract

Strengths and limitations of this study ► This study was conducted robustly, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using a comprehensive search strategy in the major medical databases, and selection and quality assessment performed by two independent reviewers. ► It offers results on the impact of panel point-of-care tests (POCTs), rather than just their accuracy. ► Included studies were relatively small, and most notably for mortality, may be underpowered to detect clinically relevant differences between laboratory and POCTs. ► Statistical and clinical heterogeneity is evident within our meta-analysis, however the meta-analysis was considered carefully and heterogeneity reduced where possible by ensuring that studies of cardiac and general panel tests were not combined; moreover, we did not combine the before-after study (which also had a high risk of bias) with randomisedcontrolled trials. ► Four studies excluded critically ill patients and patients with myocardial infarction, which may have biased mortality data. AbStrACtObjectives This article summarises all the available evidence on the impact of introducing blood-based pointof-care panel testing (POCT) in ambulatory care on patient outcomes and healthcare processes.Design Systematic review and meta-analysis of randomised-controlled trials and before-after studies. Data sources Ovid Medline, Embase, Cochrane Database of Systematic Reviews, Cochrane CENTRAL, Database of Abstracts of Reviews and Effects, Science Citation Index from inception to 22 October 2019.Eligibility criteria for selecting studies Included studies were based in ambulatory care and compared POCT with laboratory testing. The primary outcome was the time to decision regarding disposition that is, admission/ referral termed disposition decision (DD) time. Secondary outcomes included length of stay (LOS) at the ambulatory care unit/practice and mortality. results 19 562 patients from nine studies were included in the review, eight of these were randomised-controlled trials, and one was a before-after study. All the studies were based in either emergency departments or the ambulance service; no studies were from primary care settings. General panel tests performed at the POCT resulted in DDs being made 40 min faster (95% CI −42.2 to −36.6, I 2 =0%) compared with the group receiving usual care, including central laboratory testing. This in turn resulted in a reduction in LOS for patients who were subsequently discharged by 34 min (95% CI −63.7 to −5.16). No significant difference in mortality was reported.Discussion Although statistical and clinical heterogeneity is evident and only a small number of studies were included in the meta-analysis, our results suggest that POCTs might lead to faster discharge decisions. Future research should be performed in primary care and identify how POCTs can contribute meaningful changes to patient care rather than focusing on healthcare processes. PrOSPErO registration number CRD42016035426.

Effectiveness of a Mobile App in Reducing Therapeutic Turnaround Time and Facilitating Communication between Caregivers in a Pediatric Emergency Department: A Randomized Controlled Pilot Trial

“…This is partly at odds with the concerns of emergency physicians who are willing to sacrifice some analytical quality for a faster TAT [ 9 ]. This can explain the craze for point-of-care testing (POCT) as an alternative to provide timely results, as it speeds up clinical decision making and relieves ED congestion by expediting patient flow [ 36 , 37 ]. However, there is still controversy about its ability to reduce the total ED-LOS [ 38 ].…”

Roadmap for large-scale implementation of point-of-care testing in primary care in Central and Eastern European countries: the Hungarian experience

“…The purpose of our scoping review was to provide an overview regarding the identified barriers and facilitators of POCT implementation in the international literature, as well as to summarize the involved managerial challenges focusing on the PC setting. Several systematic reviews covering different POCT clinical applications, GP attitudes, and economic evidence (Lingervelder et al, 2021;Goyder et al, 2020;Jones, 2013) have been published recently, thus we aimed to incorporate a broader overview of the implementation challenges and possible solutions regarding POCT in a PC setting.…”

“…It can be observed that in European countries where POCT use is most prevalent at the GP level (specifically the Netherlands, Ireland, and the Scandinavian countries), first adapters who are also KOLs have recognized the diagnostic, therapeutic, and partly the economic benefits of POCT thus "paving" the path for subsequent adapters (Goyder et al, 2020). The cases of Australia and Canada are worth mentioning, where several key cost-effectiveness analyses have been published, and seem to be leading the way in POCT evaluation and evidence generation, hence the systematic spread and use of several POCT device in PC settings can be observed (Wong, et al, 2020;Lingervelder et al, 2021).…”

Point-of-care testing with high-sensitivity cardiac troponin assays: the challenges and opportunities

“…shown to improve the speed with which AMI patients are identified. 34 Indeed the recent PROACT-4 133 trial, where POC troponin was tested in the ambulance setting, reported only modest time-savings 134 (0.3 hour) from first medical contact to discharge from ED or admission. 35 As no studies have 135 reported the impact of utilisation of POC hs-cTn assays in actual patient care (due to the newness of 136 this technology), our understanding of the effects of accelerated risk stratification on health systems 137 is also derived from reports using lab-based assays.…”