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Domen J, Verbakel JYJ, Adriaenssens N, Scholtes B, Peeters B, Bruyndonckx R, De Sutter A, Heytens S, Van den Bruel A, Desombere I, Van Damme P, Goossens H, Buret L, Duysburgh E, Coenen S. Validation of a rapid SARS-CoV-2 antibody test in general practice. BMJ Open 2023; 13:e069997. [PMID: 37130685 PMCID: PMC10163333 DOI: 10.1136/bmjopen-2022-069997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/04/2023] Open
Abstract
OBJECTIVES To validate a rapid serological test (RST) for SARS-CoV-2 antibodies used in seroprevalence studies in healthcare providers, including primary healthcare providers (PHCPs) in Belgium. DESIGN A phase III validation study of the RST (OrientGene) within a prospective cohort study. SETTING Primary care in Belgium. PARTICIPANTS Any general practitioner (GP) working in primary care in Belgium and any other PHCP from the same GP practice who physically manages patients were eligible in the seroprevalence study. For the validation study, all participants who tested positive (376) on the RST at the first testing timepoint (T1) and a random sample of those who tested negative (790) and unclear (24) were included. INTERVENTION At T2, 4 weeks later, PHCPs performed the RST with fingerprick blood (index test) immediately after providing a serum sample to be analysed for the presence of SARS-CoV-2 immunoglobulin G antibodies using a two-out-of-three assay (reference test). PRIMARY AND SECONDARY OUTCOME MEASURES The RST accuracy was estimated using inverse probability weighting to correct for missing reference test data, and considering unclear RST results as negative for the sensitivity and positive for the specificity. Using these conservative estimates, the true seroprevalence was estimated both for T2 and RST-based prevalence values found in a cohort study with PHCPs in Belgium. RESULTS 1073 paired tests (403 positive on the reference test) were included. A sensitivity of 73% (a specificity of 92%) was found considering unclear RST results as negative (positive). For an RST-based prevalence at T1 (13.9), T2 (24.9) and T7 (70.21), the true prevalence was estimated to be 9.1%, 25.9% and 95.7%, respectively. CONCLUSION The RST sensitivity (73%) and specificity (92%) make an RST-based seroprevalence below (above) 23% overestimate (underestimate) the true seroprevalence. TRIAL REGISTRATION NUMBER NCT04779424.
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Affiliation(s)
- Julie Domen
- Department of Family Medicine and Population Health (FAMPOP), Centre for General Practice, University of Antwerp, Antwerpen, Belgium
| | - Jan Yvan Jos Verbakel
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- Department of Public Health and Primary Care, EPI-Centre, KU Leuven, Leuven, Belgium
| | - Niels Adriaenssens
- Department of Family Medicine and Population Health (FAMPOP), Centre for General Practice, University of Antwerp, Antwerpen, Belgium
| | - Beatrice Scholtes
- General Practice Department-Primary Care and Health Research Unit, Liege University, Liege, Belgium
| | - Bart Peeters
- Department of Laboratory Medicine, University Hospital Antwerp, Edegem, Belgium
| | - Robin Bruyndonckx
- Department of Family Medicine and Population Health (FAMPOP), Centre for General Practice, University of Antwerp, Antwerpen, Belgium
- Interuniversity Institute for Biostatistics and Statistical Bioinformatics (I-BioStat), Data Science Institute, Hasselt University, Hasselt, Belgium
- Epidemiology & Pharmavigilance, P95, Leuven, Belgium
| | - An De Sutter
- Department of Public Health and Primary Care, University of Ghent, Gent, Belgium
| | - Stefan Heytens
- Department of Public Health and Primary Care, University of Ghent, Gent, Belgium
| | - Ann Van den Bruel
- Department of Public Health and Primary Care, EPI-Centre, KU Leuven, Leuven, Belgium
| | - Isabelle Desombere
- Department of Infectious Diseases in Humans, Sciensano, Brussels, Belgium
| | - Pierre Van Damme
- Vaccine & Infectious Disease Institute, Centre for the Evaluation of Vaccination, University of Antwerp Faculty of Medicine and Health Sciences, Antwerpen (Wilrijk, Belgium
| | - Herman Goossens
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerpen, Belgium
| | - Laetitia Buret
- General Practice Department-Primary Care and Health Research Unit, Liege University, Liege, Belgium
| | - Els Duysburgh
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - Samuel Coenen
- Department of Family Medicine and Population Health (FAMPOP), Centre for General Practice, University of Antwerp, Antwerpen, Belgium
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerpen, Belgium
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Lingervelder D, Koffijberg H, Kusters R, IJzerman MJ. Health Economic Evidence of Point-of-Care Testing: A Systematic Review. PHARMACOECONOMICS - OPEN 2021; 5:157-173. [PMID: 33405188 PMCID: PMC8160040 DOI: 10.1007/s41669-020-00248-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/12/2020] [Indexed: 05/05/2023]
Abstract
OBJECTIVE Point-of-care testing (POCT) has become an essential diagnostic technology for optimal patient care. Its implementation, however, still falls behind. This paper reviews the available evidence on the health economic impact of introducing POCT to assess if poor POCT uptake may be related to lacking evidence. STUDY DESIGN The Scopus and PubMed databases were searched to identify publications describing a health economic evaluation of a point-of-care (POC) test. Data were extracted from the included publications, including general and methodological characteristics as well as the study results summarized in either cost, effects or an incremental cost-effectiveness ratio. Results were sorted into six groups according to the POC test's purpose (diagnosis, screening or monitoring) and care setting (primary care or secondary care). The reporting quality of the publications was determined using the CHEERS checklist. RESULTS The initial search resulted in 396 publications, of which 44 met the inclusion criteria. Most of the evaluations were performed in a primary care setting (n = 31; 70.5%) compared with a secondary care setting (n = 13; 29.5%). About two thirds of the evaluations were on POC tests implemented with a diagnostic purpose (n = 28; 63.6%). More than 75% of evaluations concluded that POCT is recommended for implementation, although in some cases only under specific circumstances and conditions. Compliance with the CHEERS checklist items ranged from 20.8% to 100%, with an average reporting quality of 72.0%. CONCLUSION There were very few evaluations in this review that advised against the implementation of POCT. However, the uptake of POCT in many countries remains low. Even though the evaluations included in this review did not always include the full long-term benefits of POCT, it is clear that health economic evidence across a few dimensions of value already indicate the benefits of POCT. This suggests that the lack of evidence on POCT is not the primary barrier to its implementation and that the low uptake of these tests in clinical practice is due to (a combination of) other barriers. In this context, aspects around organization of care, support of clinicians and quality management may be crucial in the widespread implementation of POCT.
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Affiliation(s)
- Deon Lingervelder
- Health Technology and Services Research Department, Technical Medical Centre, University of Twente, P.O. Box 217, Enschede, 7500 AE, The Netherlands
| | - Hendrik Koffijberg
- Health Technology and Services Research Department, Technical Medical Centre, University of Twente, P.O. Box 217, Enschede, 7500 AE, The Netherlands
| | - Ron Kusters
- Health Technology and Services Research Department, Technical Medical Centre, University of Twente, P.O. Box 217, Enschede, 7500 AE, The Netherlands
- Laboratory for Clinical Chemistry and Haematology, Jeroen Bosch Hospital, 's Hertogenbosch, The Netherlands
| | - Maarten J IJzerman
- Health Technology and Services Research Department, Technical Medical Centre, University of Twente, P.O. Box 217, Enschede, 7500 AE, The Netherlands.
- Cancer Health Services Research Unit, School of Population and Global Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia.
- Victorian Comprehensive Cancer Centre, Melbourne, Australia.
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Van Roy W, Woronoff G, Jimenez Valencia AM, Stakenborg T, Clarke WA. Analytical description of the lag phase in coupled-enzyme substrate assays. Biochem Eng J 2020. [DOI: 10.1016/j.bej.2020.107699] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Brookes-Howell L, Thomas-Jones E, Bates J, Bekkers MJ, Brugman C, Coulman E, Francis N, Hashmi K, Hood K, Kirby N, Llor C, Little P, Moore M, Moragas A, Rumsby K, Verheij T, Butler C. Challenges in managing urinary tract infection and the potential of a point-of-care test guided care in primary care: an international qualitative study. BJGP Open 2019; 3:bjgpopen18X101630. [PMID: 31366667 PMCID: PMC6662873 DOI: 10.3399/bjgpopen18x101630] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 10/26/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Little is known about clinicians' experiences of using a point-of-care test (POCT) to inform management of urinary tract infection (UTI) in general practice. AIM To explore experiences of using the Flexicult test to inform management of UTI and views on requirements for an optimal POCT to inform successful implementation. DESIGN & SETTING Telephone interviews with 35 primary care clinicians and healthcare professionals in Wales, England, Spain, and the Netherlands, who had participated in a trial of the Flexicult POCT for UTI based on urine culture. METHOD Thematic analysis of semi-structured interviews. RESULTS Most primary care clinicians interviewed agreed on the need for a POCT in UTI management, and that the Flexicult POCT delivered quicker results than laboratory results used in usual care, reassured patients, boosted their confidence in decision-making, and reminded them about antibiotic stewardship. However, clinicians also reported difficulties in interpreting results, limitations on when the Flexicult could be used, and concerns that testing all patients would strain care delivery and prolong patient discomfort when delaying decisions until a non-rapid POCT result was available. An optimal POCT would produce more rapid results, and be reliable and easy to use. Uptake into routine care would be enhanced by: clear guidance on which patients should be tested; training for interpreting 'grey area' results; reiterating that even 'straightforward' cases might be better managed with a test; clear messages about stopping unnecessary antibiotics versus completing a course; and better self-management strategies to accompany implementation of delayed, or non-prescription of, antibiotics. CONCLUSION Primary care clinicians believe that POCT tests could play a useful role in the management of UTI and gave clear recommendations for successful implementation.
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Affiliation(s)
- Lucy Brookes-Howell
- Research Fellow (Qualitative), Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Emma Thomas-Jones
- Research Fellow, Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Janine Bates
- Research Associate, Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Marie-Jet Bekkers
- Research Associate, Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Curt Brugman
- Project Manager, Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht, The Netherlands
| | - Elinor Coulman
- Research Associate, Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Nick Francis
- Professor, Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Khurram Hashmi
- GP Academic Fellow, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Kerenza Hood
- Professor, Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Nigel Kirby
- Senior Data Manager, Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Carl Llor
- GP and Researcher, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Paul Little
- Professor, Primary Care & Population Sciences, University of Southampton, Southampton, UK
| | - Michael Moore
- Professor, Primary Care & Population Sciences, University of Southampton, Southampton, UK
| | - Anna Moragas
- Project Manager, University Institute in Primary Care Research Jordi Gol, Via Roma Health Centre, Barcelona, Spain
- GP and Associate Professor, University Rovira i Virgili. Primary Healthcare Centre Jaume I, Tarragona, Spain
| | - Kate Rumsby
- Study Manager, Primary Care & Population Sciences, University of Southampton, Southampton, UK
| | - Theo Verheij
- Professor, Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht, The Netherlands
| | - Christopher Butler
- Professor of Primary Care, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Morgan TJ, Anstey CM. Expanding the boundaries of point of care testing. J Clin Monit Comput 2019; 34:397-399. [PMID: 31254240 DOI: 10.1007/s10877-019-00344-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 06/26/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Thomas J Morgan
- Intensive Care Unit, Mater Research - University of Queensland, Mater Health Services, Stanley Street, South Brisbane, QLD, 4101, Australia.
| | - Christopher M Anstey
- Department of Intensive Care, Sunshine Coast Hospital, Nambour, QLD, 4560, Australia.,The University of Queensland, Brisbane, QLD, 4101, Australia
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Kip MMA, Hummel JM, Eppink EB, Koffijberg H, Hopstaken RM, IJzerman MJ, Kusters R. Understanding the adoption and use of point-of-care tests in Dutch general practices using multi-criteria decision analysis. BMC FAMILY PRACTICE 2019; 20:8. [PMID: 30630430 PMCID: PMC6327588 DOI: 10.1186/s12875-018-0893-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 12/16/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND The increasing number of available point-of-care (POC) tests challenges clinicians regarding decisions on which tests to use, how to efficiently use them, and how to interpret the results. Although POC tests may offer benefits in terms of low turn-around-time, improved patient's satisfaction, and health outcomes, only few are actually used in clinical practice. Therefore, this study aims to identify which criteria are, in general, important in the decision to implement a POC test, and to determine their weight. Two POC tests available for use in Dutch general practices (i.e. the C-reactive protein (CRP) test and the glycated haemoglobin (HbA1c) test) serve as case studies. The information obtained from this study can be used to guide POC test development and their introduction in clinical practice. METHODS Relevant criteria were identified based on a literature review and semi-structured interviews with twelve experts in the field. Subsequently, the criteria were clustered in four groups (i.e. user, organization, clinical value, and socio-political context) and the relative importance of each criterion was determined by calculating geometric means as implemented in the Analytic Hierarchy Process. Of these twelve experts, ten participated in a facilitated group session, in which their priorities regarding both POC tests (compared to central laboratory testing) were elicited. RESULTS Of 20 criteria in four clusters, the test's clinical utility, its technical performance, and risks (associated with the treatment decision based on the test result) were considered most important for using a POC test, with relative weights of 22.2, 12.6 and 8.5%, respectively. Overall, the experts preferred the POC CRP test over its laboratory equivalent, whereas they did not prefer the POC HbA1c test. This difference was mainly explained by their strong preference for the POC CRP test with regard to the subcriterion 'clinical utility'. CONCLUSIONS The list of identified criteria, and the insights in their relative impact on successful implementation of POC tests, may facilitate implementation and use of existing POC tests in clinical practice. In addition, having experts score new POC tests on these criteria, provides developers with specific recommendations on how to increase the probability of successful implementation and use.
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Affiliation(s)
- Michelle M A Kip
- Department of Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, P.O. Box 217, 7500, AE, Enschede, The Netherlands.
| | - J Marjan Hummel
- Department of Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, P.O. Box 217, 7500, AE, Enschede, The Netherlands
| | - Elra B Eppink
- Department of Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, P.O. Box 217, 7500, AE, Enschede, The Netherlands
| | - Hendrik Koffijberg
- Department of Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, P.O. Box 217, 7500, AE, Enschede, The Netherlands
| | | | - Maarten J IJzerman
- Department of Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, P.O. Box 217, 7500, AE, Enschede, The Netherlands
| | - Ron Kusters
- Department of Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, P.O. Box 217, 7500, AE, Enschede, The Netherlands.,Laboratory for Clinical Chemistry and Haematology, Jeroen Bosch Ziekenhuis, Den Bosch, The Netherlands
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7
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Point-of-care testing in primary care: needs and attitudes of Irish GPs. BJGP Open 2018; 1:bjgpopen17X101229. [PMID: 30564692 PMCID: PMC6181093 DOI: 10.3399/bjgpopen17x101229] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 08/29/2017] [Indexed: 11/21/2022] Open
Abstract
Background Studies outside of Ireland have demonstrated that GPs believe point-of-care tests (POCTs) are useful and would like to have more of these tests available in daily practice. This study establishes the views of Irish GPs on this topic for the first time and also explores GPs’ perceptions of barriers to having POCT devices in primary care. Aim To establish Irish GPs' perception of the benefits and barriers to POCT use. Design & setting A quantitative cross-sectional observational survey of Irish GPs attending continuing medical educational meetings (CME) in November 2015. Method Data was collected using an anonymous and confidential questionnaire. Results Out of a total of 250, 70% of GPs (n = 143) completed the questionnaire. Of these, 92% (n = 132) indicated they would like to have access to POCTs. Guidance in decision making 43% (n = 61), reduced referral rates 29% (n = 42), and diagnosis assistance 13% (n = 18) were the main benefits expressed. Cost 45% (n = 64) and time 34% (n = 48) were the main barriers identified. Conclusion This study proved that Irish GPs would also like increased access to POCTs. They feel that these tests would benefit patient care. Unsurprisingly, cost and time were two barriers identified to using POCT devices, which supports outcomes from studies. Radical changes would be required in primary care to facilitate implementation of POCTs and attention must be paid to how the costs of POCTs will be funded. This study may act as a prompt for future international research to further explore this area.
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Stavelin A, Sandberg S. Essential aspects of external quality assurance for point-of-care testing. Biochem Med (Zagreb) 2017; 27:81-85. [PMID: 28392729 PMCID: PMC5382857 DOI: 10.11613/bm.2017.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Accepted: 12/24/2016] [Indexed: 11/18/2022] Open
Abstract
External quality assurance (EQA) or proficiency testing for point-of-care (POC) testing is in principle similar to EQA for larger hospital laboratories, but the participants are different. The participants are usually health care personnel with little or no knowledge of laboratory medicine. The implication of this is that the EQA provider has to a) convince the participants that participation in EQA schemes are important, b) be able to circulate materials with reasonable time intervals, c) produce feedback reports that are understandable, and d) offer help and guidance to the participants when needed. It is also important that EQA for POC testing e) address the pre-examination, the examination and the post-examination processes, and f) that schemes for measurement procedures using interval or ordinal scale are offered. The aim of the present paper is to highlight important issues of these essential aspects of EQA for POC testing.
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Affiliation(s)
- Anne Stavelin
- The Norwegian Quality Improvement of Primary Care Laboratories (Noklus), Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Sverre Sandberg
- The Norwegian Quality Improvement of Primary Care Laboratories (Noklus), Haraldsplass Deaconess Hospital, Bergen, Norway.; Department of Public Health and Primary Health Care, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
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Howick J, Bossuyt PM, Cals JWL. Point of care testing in family practice: common myths debunked. Fam Pract 2017; 34:373-375. [PMID: 27543793 DOI: 10.1093/fampra/cmw082] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Affiliation(s)
- Jeremy Howick
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Patrick M Bossuyt
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Jochen W L Cals
- Department of Family Medicine, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
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Llor C, Alkorta Gurrutxaga M, de la Flor I Bru J, Bernárdez Carracedo S, Cañada Merino JL, Bárcena Caamaño M, Serrano Martino C, Cots Yago JM. [Recommendations for the use of rapid diagnosis techniques in respiratory infections in primary care]. Aten Primaria 2017. [PMID: 28623011 PMCID: PMC6875920 DOI: 10.1016/j.aprim.2017.03.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Respiratory tract infections rank first as causes of adult and paediatric infectious morbidity in primary care in Spain. These infections are usually self-limiting and are mainly caused by viruses. However, a high percentage of unnecessary antibiotic prescription is reported. Point-of-care tests are biomedical tests, which can be used near the patient, without interference of a laboratory. The use of these tests, many of which have been recently developed, is rapidly increasing in general practice. Notwithstanding, we must mull over whether they always contribute to an effective and high-quality diagnostic process by primary care clinicians. We present a set of criteria that can be used by clinicians and discuss the pros and cons of the instruments available for the management of respiratory tract infections and how to use them appropriately.
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Affiliation(s)
- Carles Llor
- Grupo de Trabajo de Enfermedades Infecciosas de la Sociedad Española de Medicina Familiar y Comunitaria (SemFYC), Centro de Salud Via Roma, Barcelona, España.
| | - Miriam Alkorta Gurrutxaga
- Grupo de Estudio de Infección en la Atención Primaria de la Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (GEIAP-SEIMC), Servicio de Microbiología, Hospital de Donostia, Osakidetza, Donostia, España
| | - Josep de la Flor I Bru
- Grupo de Trabajo de Tecnologías Diagnósticas de la Sociedad Española de Pediatría Extrahospitalaria y Atención Primaria (SEPEAP), Centro de Salud El Serral, Institut Català de la Salut, Sant Vicenç dels Horts, España
| | - Sílvia Bernárdez Carracedo
- Grupo de Trabajo de Tecnologías Diagnósticas de la Sociedad Española de Pediatría Extrahospitalaria y Atención Primaria (SEPEAP), Centro de Salud Dr. Robert, Institut Català de la Salut, Badalona, España
| | - José Luis Cañada Merino
- Grupo de Trabajo de Enfermedades Infecciosas, Medicina Tropical y del Viajero de la Sociedad Española de Médicos de Atención Primaria (SEMERGEN), Sendagile orokorra erretirodun, Osakidetza, Getxo, España
| | - Mario Bárcena Caamaño
- Grupo de Trabajo de Patología Infecciosa del Aparato Respiratorio de la Sociedad Española de Médicos Generales y de Familia (SEMG), Centro de Salud Valdefierro, Zaragoza, España
| | - Carmen Serrano Martino
- Grupo de Estudio de Infección en la Atención Primaria de la Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (GEIAP-SEIMC), Hospital San Juan de Dios, Bormujos, Sevilla, España
| | - Josep Maria Cots Yago
- Grupo de Trabajo de Enfermedades Infecciosas de la Sociedad Española de Medicina Familiar y Comunitaria (SemFYC), Universidad de Barcelona, Centro de Salud La Marina, Institut Català de la Salut, Barcelona, España
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Wells S, Rafter N, Kenealy T, Herd G, Eggleton K, Lightfoot R, Arcus K, Wadham A, Jiang Y, Bullen C. 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. PLoS One 2017; 12:e0174504. [PMID: 28422968 PMCID: PMC5396877 DOI: 10.1371/journal.pone.0174504] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Accepted: 02/22/2017] [Indexed: 11/23/2022] Open
Abstract
Objectives To 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. Methods We 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. Results A 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. Conclusions Performance 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 registration Australian New Zealand Clinical Trials Registry ACTRN12613000607774
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Affiliation(s)
- Sue Wells
- Section of Epidemiology and Biostatistics, School of Population Health, University of Auckland, Auckland, New Zealand
- * E-mail:
| | - Natasha Rafter
- National Institute for Health Innovation, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Timothy Kenealy
- Department of General Practice and Primary Health Care, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Geoff Herd
- Whangarei Hospital, Northland District Health Board, Whangarei, New Zealand
| | - Kyle Eggleton
- Department of General Practice and Primary Health Care, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Rose Lightfoot
- Te Tai Tokerau Primary Health Organisation, Kaitaia, New Zealand
| | - Kim Arcus
- The National Heart Foundation of New Zealand, Auckland, New Zealand
| | - Angela Wadham
- National Institute for Health Innovation, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Yannan Jiang
- National Institute for Health Innovation, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Chris Bullen
- National Institute for Health Innovation, School of Population Health, University of Auckland, Auckland, New Zealand
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12
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Kaczor-Urbanowicz KE, Martín Carreras-Presas C, Kaczor T, Tu M, Wei F, Garcia-Godoy F, Wong DTW. Emerging technologies for salivaomics in cancer detection. J Cell Mol Med 2016; 21:640-647. [PMID: 27862926 PMCID: PMC5345659 DOI: 10.1111/jcmm.13007] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 09/13/2016] [Indexed: 01/04/2023] Open
Abstract
Salivary diagnostics has great potential to be used in the early detection and prevention of many cancerous diseases. If implemented with rigour and efficiency, it can result in improving patient survival times and achieving earlier diagnosis of disease. Recently, extraordinary efforts have been taken to develop non‐invasive technologies that can be applied without complicated and expensive procedures. Saliva is a biofluid that has demonstrated excellent properties and can be used as a diagnostic fluid, since many of the biomarkers suggested for cancers can also be found in whole saliva, apart from blood or other body fluids. The currently accepted gold standard methods for biomarker development include chromatography, mass spectometry, gel electrophoresis, microarrays and polymerase chain reaction‐based quantification. However, salivary diagnostics is a flourishing field with the rapid development of novel technologies associated with point‐of‐care diagnostics, RNA sequencing, electrochemical detection and liquid biopsy. Those technologies will help introduce population‐based screening programs, thus enabling early detection, prognosis assessment and disease monitoring. The purpose of this review is to give a comprehensive update on the emerging diagnostic technologies and tools for the early detection of cancerous diseases based on saliva.
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Affiliation(s)
| | | | - Tadeusz Kaczor
- Faculty of Mechanical Engineering, Department of Physics, Kazimierz Pulaski University of Technology and Humanities in Radom, Radom, Poland
| | - Michael Tu
- Center for Oral/Head & Neck Oncology Research, School of Dentistry, University of California at Los Angeles, Los Angeles, CA, USA
| | - Fang Wei
- Center for Oral/Head & Neck Oncology Research, School of Dentistry, University of California at Los Angeles, Los Angeles, CA, USA
| | - Franklin Garcia-Godoy
- Bioscience Research Center, College of Dentistry, University of Tennessee Health Science Center, Memphis, TN, USA
| | - David T W Wong
- Center for Oral/Head & Neck Oncology Research, School of Dentistry, University of California at Los Angeles, Los Angeles, CA, USA
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13
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Borsci S, Buckle P, Hanna GB. Why you need to include human factors in clinical and empirical studies ofin vitropoint of care devices? Review and future perspectives. Expert Rev Med Devices 2016; 13:405-16. [DOI: 10.1586/17434440.2016.1154277] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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14
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Lucassen WAM, Erkens PMG, Geersing GJ, Büller HR, Moons KGM, Stoffers HEJH, van Weert HCPM. Qualitative point-of-care D-dimer testing compared with quantitative D-dimer testing in excluding pulmonary embolism in primary care. J Thromb Haemost 2015; 13:1004-9. [PMID: 25845618 DOI: 10.1111/jth.12951] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 03/29/2015] [Indexed: 08/31/2023]
Abstract
BACKGROUND General practitioners can safely exclude pulmonary embolism (PE) by using the Wells PE rule combined with D-dimer testing. OBJECTIVE To compare the accuracy of a strategy using the Wells rule combined with either a qualitative point-of-care (POC) D-dimer test performed in primary care or a quantitative laboratory-based D-dimer test. METHODS We used data from a prospective cohort study including 598 adults suspected of PE in primary care in the Netherlands. General practitioners scored the Wells rule and carried out a qualitative POC test. All patients were referred to hospital for reference testing. We obtained quantitative D-dimer test results as performed in hospital laboratories. The primary outcome was the prevalence of venous thromboembolism in low-risk patients. RESULTS Prevalence of PE was 12.2%. POC D-dimer test results were available in 582 patients (97%). Quantitative test results were available in 401 patients (67%). We imputed results in 197 patients. The quantitative test and POC test missed one (0.4%) and four patients (1.5%), respectively, with a negative strategy (Wells ≤ 4 points and D-dimer test negative) (P = 0.20). The POC test could exclude 23 more patients (4%) (P = 0.05). The sensitivity and specificity of the Wells rule combined with a POC test were 94.5% and 51.0% and, combined with a quantitative test, 98.6% and 47.2%, respectively. CONCLUSIONS Combined with the Wells PE rule, both tests are safe to use in excluding PE. The quantitative test seemed to be safer than the POC test, albeit not statistically significant. The specificity of the POC test was higher, resulting in more patients in whom PE could be excluded.
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Affiliation(s)
- W A M Lucassen
- Department of Family Medicine, Academic Medical Center, Amsterdam, the Netherlands
| | - P M G Erkens
- Department of Family Medicine, University of Maastricht, Maastricht, the Netherlands
| | - G J Geersing
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - H R Büller
- Department of Vascular Medicine, Academic Medical Center, Amsterdam, the Netherlands
| | - K G M Moons
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - H E J H Stoffers
- Department of Family Medicine, University of Maastricht, Maastricht, the Netherlands
| | - H C P M van Weert
- Department of Family Medicine, Academic Medical Center, Amsterdam, the Netherlands
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15
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Llor C, Bjerrum L. Antimicrobial resistance: risk associated with antibiotic overuse and initiatives to reduce the problem. Ther Adv Drug Saf 2014; 5:229-41. [PMID: 25436105 DOI: 10.1177/2042098614554919] [Citation(s) in RCA: 855] [Impact Index Per Article: 85.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Antimicrobial resistance is a global public health challenge, which has accelerated by the overuse of antibiotics worldwide. Increased antimicrobial resistance is the cause of severe infections, complications, longer hospital stays and increased mortality. Overprescribing of antibiotics is associated with an increased risk of adverse effects, more frequent re-attendance and increased medicalization of self-limiting conditions. Antibiotic overprescribing is a particular problem in primary care, where viruses cause most infections. About 90% of all antibiotic prescriptions are issued by general practitioners, and respiratory tract infections are the leading reason for prescribing. Multifaceted interventions to reduce overuse of antibiotics have been found to be effective and better than single initiatives. Interventions should encompass the enforcement of the policy of prohibiting the over-the-counter sale of antibiotics, the use of antimicrobial stewardship programmes, the active participation of clinicians in audits, the utilization of valid rapid point-of-care tests, the promotion of delayed antibiotic prescribing strategies, the enhancement of communication skills with patients with the aid of information brochures and the performance of more pragmatic studies in primary care with outcomes that are of clinicians' interest, such as complications and clinical outcomes.
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Affiliation(s)
- Carl Llor
- School of Medicine, Cardiff University, Department of Primary Care and Public Health, 5th Floor Neuadd Meirionnydd, Heath Park, Cardiff CF14 4XN, UK
| | - Lars Bjerrum
- Section of General Practice and Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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16
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Howick J, Cals JWL, Jones C, Price CP, Plüddemann A, Heneghan C, Berger MY, Buntinx F, Hickner J, Pace W, Badrick T, Van den Bruel A, Laurence C, van Weert HC, van Severen E, Parrella A, Thompson M. Current and future use of point-of-care tests in primary care: an international survey in Australia, Belgium, The Netherlands, the UK and the USA. BMJ Open 2014; 4:e005611. [PMID: 25107438 PMCID: PMC4127935 DOI: 10.1136/bmjopen-2014-005611] [Citation(s) in RCA: 111] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE Despite the growing number of point-of-care (POC) tests available, little research has assessed primary care clinician need for such tests. We therefore aimed to determine which POC tests they actually use or would like to use (if not currently available in their practice). DESIGN Cross-sectional survey. SETTING Primary care in Australia, Belgium (Flanders region only), the Netherlands, the UK and the USA. PARTICIPANTS Primary care doctors (general practitioners, family physicians). MAIN MEASURES We asked respondents to (1) identify conditions for which a POC test could help inform diagnosis, (2) from a list of tests provided: evaluate which POC tests they currently use (and how frequently) and (3) determine which tests (from that same list) they would like to use in the future (and how frequently). RESULTS 2770 primary care clinicians across five countries responded. Respondents in all countries wanted POC tests to help them diagnose acute conditions (infections, acute cardiac disease, pulmonary embolism/deep vein thrombosis), and some chronic conditions (diabetes, anaemia). Based on the list of POC tests provided, the most common tests currently used were: urine pregnancy, urine leucocytes or nitrite and blood glucose. The most commonly reported tests respondents expressed a wish to use in the future were: D-dimer, troponin and chlamydia. The UK and the USA reported a higher actual and desired use for POC tests than Australia, Belgium and the Netherlands. Our limited data suggest (but do not confirm) representativeness. CONCLUSIONS Primary care clinicians in all five countries expressed a desire for POC tests to help them diagnose a range of acute and chronic conditions. Rates of current reported use and desired future use were generally high for a small selection of POC tests, but varied across countries. Future research is warranted to explore how specific POC tests might improve primary care.
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Affiliation(s)
- Jeremy Howick
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Jochen W L Cals
- Deptartment of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | - Caroline Jones
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Christopher P Price
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Annette Plüddemann
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Carl Heneghan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Marjolein Y Berger
- Department of General Practice, University of Groningen, Groningen, The Netherlands
| | - Frank Buntinx
- Deptartment of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
- Academic Center for General Practice, Leuven, Belgium
| | - John Hickner
- Family Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Wilson Pace
- Department of Family Medicine, University of Colorado, Aurora, Colorado, USA
| | - Tony Badrick
- Faculty of Health Sciences and Medicine, Bond University, Queensland, Australia
| | - Ann Van den Bruel
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Caroline Laurence
- Discipline of General Practice, The University of Adelaide, Adelaide, South Australia, Australia
| | - Henk C van Weert
- Department of General Practice, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Adriana Parrella
- Discipline of General Practice, The University of Adelaide, Adelaide, South Australia, Australia
| | - Matthew Thompson
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
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17
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Llor C. ¿Puede mejorar el consumo de antimicrobianos en los pacientes ambulatorios de nuestro país? Enferm Infecc Microbiol Clin 2014; 32:409-11. [DOI: 10.1016/j.eimc.2014.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2014] [Accepted: 03/18/2014] [Indexed: 10/25/2022]
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18
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Affiliation(s)
- Carl Llor
- Institute of Primary Care and Public Health, School of Medicine, Cardiff University
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van Weert H. Family medicine and Eurologic. Eur J Gen Pract 2013; 19:211-2. [PMID: 24261424 DOI: 10.3109/13814788.2013.854769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Henk van Weert
- Professor and head of Department of General Practice, Academic Medical Centre Amsterdam , The Netherlands
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