&lt;p&gt;Review of Health Economics of Point-of-Care Testing Worldwide and Its Efficacy of Implementation in the Primary Health Care Setting in Remote Australia&lt;/p&gt;

Wong, Hoi Yan; Marcu, Loredana G.; Bezak, Eva; Parange, Nayana

doi:10.2147/rmhp.s247774

Cited by 14 publications

(8 citation statements)

References 45 publications

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“…This is particularly valuable to those living in rural and regional areas with limited access to healthcare services. 39 , 40 The use of urate self‐monitoring devices (alongside apps and support from healthcare providers) at home has been shown to be convenient, improve understanding, and communication. 41 Further, the inability to self‐monitor at home, or if the device was too expensive, would prevent frequent monitoring.…”

Section: Discussionmentioning

confidence: 99%

The experiences and perspectives of people with gout on urate self‐monitoring

Michael,

Chan,

Hughes

et al. 2024

Health Expectations

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IntroductionGout management remains suboptimal despite safe and effective urate‐lowering therapy. Self‐monitoring of urate may improve gout management, however, the acceptability of urate self‐monitoring by people with gout is unknown. The aim of this study was to explore the experiences of urate self‐monitoring in people with gout.MethodsSemistructured interviews were conducted with people taking urate‐lowering therapy (N = 30) in a 12‐month trial of urate self‐monitoring in rural and urban Australia. Interviews covered the experience of monitoring and its effect on gout self‐management. Deidentified transcripts were analysed thematically.ResultsParticipants valued the ability to self‐monitor and gain more understanding of urate control compared with the annual monitoring ordered by their doctors. Participants indicated that self‐monitoring at home was easy, convenient and informed gout self‐management behaviours such as dietary modifications, hydration, exercise and medication routines. Many participants self‐monitored to understand urate concentration changes in response to feeling a gout flare was imminent or whether their behaviours, for example, alcohol intake, increased the risk of a gout flare. Urate concentrations were shared with doctors mainly when they were above target to seek management support, and this led to allopurinol dose increases in some cases.ConclusionUrate self‐monitoring was viewed by people with gout as convenient and useful for independent management of gout. They believed self‐monitoring achieved better gout control with a less restricted lifestyle. Urate data was shared with doctors at the patient's discretion and helped inform clinical decisions, such as allopurinol dose changes. Further research on implementing urate self‐monitoring in routine care would enable an evaluation of its impact on medication adherence and clinical outcomes, as well as inform gout management guidelines.Patient or Public ContributionOne person with gout, who was not a participant, was involved in the study design by providing feedback and pilot testing the semistructured interview guide. In response to their feedback, subsequent modifications to the interview guide were made to improve the understandability of the questions from a patient perspective. No additional questions were suggested.

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Section: Discussionmentioning

confidence: 99%

The experiences and perspectives of people with gout on urate self‐monitoring

Michael,

Chan,

Hughes

et al. 2024

Health Expectations

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“…Despite POCTs being considered especially beneficial to resource-limited health systems of LMICs, this study, in line with others, shows their use to be appreciated also in a wellresourced context, despite high accessibility to more advanced laboratory diagnostics and skilled personnel. [4,5,7,8,[20][21][22][23] POCTs are often less invasive and require smaller volumes of patient specimens than central laboratory facilities, which, together with their evolving multiplexity, promotes their use in paediatric clinics. [2,24] In our study, POCTs were merited as facilitators of patient management by accelerating differential diagnostics and patient flow at the PED, being favourable to paediatric clientele and essential to the emergency department setting of this study.…”

Section: Discussionmentioning

confidence: 99%

Point-of-care testing in a high-income country paediatric emergency department – a qualitative study in Sweden

Rasti

Brännström

Mårtensson

et al. 2021

Preprint

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ObjectivesIn many resource-limited health systems, point-of-care tests (POCTs) are the only means for clinical patient sample analyses. However, the speed and simplicity of POCTs also makes their use appealing to clinicians in high-income countries (HICs), despite their having greater laboratory accessibility. Although also part of the clinical routine in HICs, the utility of POCTs is relatively unknown in such settings as compared to others.In a Swedish paediatric emergency department (PED) where POCT use is routine, we aimed to characterize health care providers’ perspectives on the clinical utility of POCTs and explore their implementation in the local setting; to compare such experiences to those reported in other settings; and finally, to gather requests for ideal novel POCTs.DesignQualitative study using focus group discussions. A data-driven content analysis approach was used for analysis.SettingThe PED of a secondary paediatric hospital in Stockholm, Sweden.ParticipantsTwenty-four health care providers clinically active at the PED were enrolled in six focus groups.ResultsA range of POCTs was routinely used. The emerging theme Utility of POCTs is double-edged illustrated the perceived utility of POCTs. While POCT services were considered to have clinical and social value, the local testing practice was named to distract from the care for patients. Requests were made for novel POCTs and their implementation.ConclusionDespite their clinical integration, deficient implementation routines limit the benefits of POCT services to this well-resourced paediatric clinic. As such deficiencies are shared with other settings, it is suggested that some characteristics of POCTs and of their utility are less related to resource level and more to policy deficiency. To address this, we propose the appointment of skilled laboratory personnel as ambassadors to hospital clinics offering POCT services, to ensure higher utility of such services.ARTICLE SUMMARYStrengths and limitations of this studyThis is the first study to present the use and utility of POCTs in a HIC paediatric hospital setting, directly from the perspective of its clinical staff.Our main finding is that deficient implementation routines limit benefit of POCT services in this well-resourced setting, strongly indicating that such deficiencies are irrespective of resource level, and more related to policy deficiency.The findings of the relatively small study size may be contextual, yet we believe our main conclusions to be generalizable as most of our findings are compatible with those reported in other settings.The study is strengthened by the diversity of its participants, corresponding to the multi-professional staffing of the PED.

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“…In the United Kingdom, a primary care study also reported that POC testing was cost effective, in comparison to laboratory testing, when used to perform routine health checks as the results were available at the first consultation [33]. A review of POC testing health economics in remote primary health care settings also provided general support for POC testing benefits to health services outweighing the associated costs [35]. In Australia, the Medical Services Advisory Committee (MSAC), is an independent, non-statutory committee established by the Minister for Health, that is responsible for the appraisal of new medical services proposed for public funding, including POC testing.…”

Section: Economic Outcomesmentioning

confidence: 99%

Patient-Centred Point-of-Care Testing: A Life-Changing Technology for Remote Primary Care

Spaeth¹,

Matthews²,

Shephard³

2022

Primary Health Care

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Point-of-care (POC) testing has proven to be a life-changing and transformational technology for patients with acute, chronic, and infectious diseases who live in regional and remote Australia. This technology facilitates patient-centred test results, of equivalent laboratory quality, that are rapidly available to inform clinical and public health decisions with immediate impact on case management. Traditionally, POC testing in high-middle income countries has been most widely used in tertiary or acute care settings to provide rapid diagnostic results for emergency departments, intensive care units, operating theatres and outpatient clinics. However, in low-middle income countries, POC tests are commonly used during antenatal and perinatal care for infectious disease detection, such as Human immunodeficiency virus (HIV) or syphilis, where laboratory services are too expensive, inaccessible, or non-existent. Similarly, the application of POC testing in primary care settings in Australia offers improved healthcare benefits to geographically isolated regional and remote communities, where access to laboratory-based pathology testing is poor and the burden of disease is high. Evidence-based data from research in established primary care POC testing networks for acute chronic, and infectious disease is used to describe the clinical, cultural, and economic effectiveness of POC technologies. Innovative solutions to address current barriers to the uptake of POC testing in primary care settings, which include clinical and cultural governance, high staff turnover, operator training and competency, device connectivity, quality testing, sustainable funding strategies, and the need for regulatory requirements are also discussed. POC testing can provide practical and resourceful opportunities to revolutionise the delivery of pathology services in rural and remote primary care sectors, where the clinical and community need for this technology is greatest. However, several barriers to the scale-up and sustainability of POC testing networks in these settings still exist, and the full potential of POC testing cannot be realised until these limitations are addressed and resolved.

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<p>Review of Health Economics of Point-of-Care Testing Worldwide and Its Efficacy of Implementation in the Primary Health Care Setting in Remote Australia</p>

Cited by 14 publications

References 45 publications

The experiences and perspectives of people with gout on urate self‐monitoring

The experiences and perspectives of people with gout on urate self‐monitoring

Point-of-care testing in a high-income country paediatric emergency department – a qualitative study in Sweden

Patient-Centred Point-of-Care Testing: A Life-Changing Technology for Remote Primary Care

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