Point-of-care testing in general practice: just what the doctor ordered?

Schols, Angel M R; Dinant, Geert-Jan; Cals, Jochen

doi:10.3399/bjgp18x698033

Cited by 15 publications

(16 citation statements)

References 10 publications

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“…Further work is required to study the impact of POCT on important public health tasks for sentinel surveillance, including influenza notification as well as infection control, and to study the cost-benefits of POCT in UK general practice. 28…”

Section: Implications For Researchmentioning

confidence: 99%

Integrating molecular point-of-care testing for influenza into primary care: a mixed-methods feasibility study

et al. 2020

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BackgroundMolecular point-of-care testing (POCT) for influenza in primary care could influence clinical care and patient outcomes.AimTo assess the feasibility of incorporating influenza POCT into general practice in England.Design and settingA mixed-methods study conducted in six general practices that had not previously participated in respiratory virology sampling, which are part of the Royal College of General Practitioners Research and Surveillance Centre English sentinel surveillance network, from February 2019 to May 2019.MethodA sociotechnical perspective was adopted using the Public Health England POCT implementation toolkit and business process modelling notation to inform qualitative analysis. Quantitative data were collected about the number of samples taken, their representativeness, and the virology results obtained, comparing them with the rest of the sentinel system over the same weeks.ResultsA total of 312 POCTs were performed; 276 were used for quantitative analysis, of which 60 were positive for influenza and 216 were negative. The average swabbing rate was 0.4 per 1000 population and swab positivity was between 16.7% (n = 14/84) and 41.4% (n = 12/29). Given a positive influenza POCT result, the odds ratio of receiving an antiviral was 14.1 (95% confidence intervals [CI] = 2.9 to 70.0, P<0.001) and of receiving an antibiotic was 0.4 (95% CI = 0.2 to 0.8, P = 0.01), compared with patients with a negative result. Qualitative analysis showed that it was feasible for practices to implement POCT, but there is considerable variation in the processes used.ConclusionTesting for influenza using POCT is feasible in primary care and may improve antimicrobial use. However, further evidence from randomised trials of influenza POCT in general practice is needed.

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Section: Implications For Researchmentioning

confidence: 99%

Integrating molecular point-of-care testing for influenza into primary care: a mixed-methods feasibility study

et al. 2020

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“…However, we think that these two elements should go hand-in-hand in order to increase the compliance to the new test strategy and prevent missed diagnoses, over-diagnosis and unnecessary costs for patients and wider society. 22 63 This is of similar importance when a test is implemented in a real-world setting.…”

Section: Discussionmentioning

confidence: 99%

“…18 The last decade has seen an increasing focus on pointof-care testing (POCT) in primary care to improve rapid decision-making and triage at the time and place of patient care. [22][23][24] FCal is available as a POCT for which results are available the same day and samples do not need to be sent to a laboratory, yet it retains characteristics that are comparable to the standard laboratory test. [25][26][27] Therefore, the FCal-POCT could decrease a GPs diagnostic uncertainty and provide early reassurance for both parents and children that a potential harmful disease (IBD) can be safely excluded.…”

Section: Introduction Background and Rationalementioning

confidence: 99%

“…To optimise FCal-POCT implementation, proper training is needed about its indication, interpretation and follow-up. 22 Perceived parental pressure for a referral is another relevant factor that may influence the decision to refer children with chronic gastrointestinal symptoms. Therefore, GPs must also receive communication skills training to explain the results, the pros and cons of referral, the natural course of (functional) symptoms and when to consult again.…”

Section: Introductionmentioning

confidence: 99%

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Effect of faecal calprotectin testing on referrals for children with chronic gastrointestinal symptoms in primary care: study protocol for a cluster randomised controlled trial

et al. 2021

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IntroductionChildren with chronic gastrointestinal symptoms are frequently seen in primary care, yet general practitioners (GPs) often experience challenges distinguishing functional gastrointestinal disorders (FGID) from organic disorders. We, therefore, aim to evaluate whether a test strategy that includes point-of-care testing (POCT) for faecal calprotectin (FCal) can reduce the referral rate to paediatric specialist care among children with chronic gastrointestinal symptoms. The study findings will contribute to improving the recommendations on FCal use among children in primary care.Methods and analysisIn this pragmatic cluster randomised controlled trial, we will randomise general practices into intervention and control groups. The intervention group will use FCal-POCT when indicated, after completing online training about its indication, interpretation and follow-up as well as communicating an FGID diagnosis. The control group will test and treat according to Dutch GP guidelines, which advise against FCal testing in children. GPs will include children aged 4–18 years presenting to primary care with chronic diarrhoea and/or recurrent abdominal pain. The primary outcome will be the referral rate for children with chronic gastrointestinal symptoms within 6 months after the initial assessment. Secondary outcomes will be evaluated by questionnaires completed at baseline and at 3- and 6-month follow-up. These outcomes will include parental satisfaction and concerns, gastrointestinal symptoms, impact of symptoms on daily function, quality of life, proportion of children with paediatrician-diagnosed FGID referred to secondary care, health service use and healthcare costs. A sample size calculation indicates that we need to recruit 158 GP practices to recruit 406 children.Ethics and disseminationThe Medical Research Ethics Committee (MREC) of the University Medical Center Groningen (The Netherlands) approved this study (MREC number: 201900309). The study results will be made available to patients, GPs, paediatricians and laboratories via peer-reviewed publications and in presentations at (inter)national conferences.Trial registration numberThe Netherlands Trial Register: NL7690 (Pre-results)

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“…There are plans to add further platforms to the hub in the near future. The next platform may be a Diagnostics Platform, which will support implementation of a range of new diagnostic tests in primary care [28]. Rapid point of care tests for influenza have previously been piloted in the RCGP sentinel network [29].…”

Section: Strengthsmentioning

confidence: 99%

The Oxford Royal College of General Practitioners Clinical Informatics Digital Hub: Protocol to Develop Extended COVID-19 Surveillance and Trial Platforms (Preprint)

Lusignan¹,

Jones²,

Dorward³

et al. 2020

Preprint

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BACKGROUND

Routinely recorded primary care data have been used for many years by sentinel networks for surveillance. More recently, real world data have been used for a wider range of research projects to support rapid, inexpensive clinical trials. Because the partial national lockdown in the United Kingdom due to the coronavirus disease (COVID-19) pandemic has resulted in decreasing community disease incidence, much larger numbers of general practices are needed to deliver effective COVID-19 surveillance and contribute to in-pandemic clinical trials.

OBJECTIVE

The aim of this protocol is to describe the rapid design and development of the Oxford Royal College of General Practitioners Clinical Informatics Digital Hub (ORCHID) and its first two platforms. The Surveillance Platform will provide extended primary care surveillance, while the Trials Platform is a streamlined clinical trials platform that will be integrated into routine primary care practice.

METHODS

We will apply the FAIR (Findable, Accessible, Interoperable, and Reusable) metadata principles to a new, integrated digital health hub that will extract routinely collected general practice electronic health data for use in clinical trials and provide enhanced communicable disease surveillance. The hub will be findable through membership in Health Data Research UK and European metadata repositories. Accessibility through an online application system will provide access to study-ready data sets or developed custom data sets. Interoperability will be facilitated by fixed linkage to other key sources such as Hospital Episodes Statistics and the Office of National Statistics using pseudonymized data. All semantic descriptors (ie, ontologies) and code used for analysis will be made available to accelerate analyses. We will also make data available using common data models, starting with the US Food and Drug Administration Sentinel and Observational Medical Outcomes Partnership approaches, to facilitate international studies. The Surveillance Platform will provide access to data for health protection and promotion work as authorized through agreements between Oxford, the Royal College of General Practitioners, and Public Health England. All studies using the Trials Platform will go through appropriate ethical and other regulatory approval processes.

RESULTS

The hub will be a bottom-up, professionally led network that will provide benefits for member practices, our health service, and the population served. Data will only be used for SQUIRE (surveillance, quality improvement, research, and education) purposes. We have already received positive responses from practices, and the number of practices in the network has doubled to over 1150 since February 2020. COVID-19 surveillance has resulted in tripling of the number of virology sites to 293 (target 300), which has aided the collection of the largest ever weekly total of surveillance swabs in the United Kingdom as well as over 3000 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) serology samples. Practices are recruiting to the PRINCIPLE (Platform Randomised trial of INterventions against COVID-19 In older PeopLE) trial, and these participants will be followed up through ORCHID. These initial outputs demonstrate the feasibility of ORCHID to provide an extended national digital health hub.

CONCLUSIONS

ORCHID will provide equitable and innovative use of big data through a professionally led national primary care network and the application of FAIR principles. The secure data hub will host routinely collected general practice data linked to other key health care repositories for clinical trials and support enhanced in situ surveillance without always requiring large volume data extracts. ORCHID will support rapid data extraction, analysis, and dissemination with the aim of improving future research and development in general practice to positively impact patient care.

INTERNATIONAL REGISTERED REPORT

DERR1-10.2196/19773

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Point-of-care testing in general practice: just what the doctor ordered?

Cited by 15 publications

References 10 publications

Integrating molecular point-of-care testing for influenza into primary care: a mixed-methods feasibility study

Integrating molecular point-of-care testing for influenza into primary care: a mixed-methods feasibility study

Effect of faecal calprotectin testing on referrals for children with chronic gastrointestinal symptoms in primary care: study protocol for a cluster randomised controlled trial

The Oxford Royal College of General Practitioners Clinical Informatics Digital Hub: Protocol to Develop Extended COVID-19 Surveillance and Trial Platforms (Preprint)

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