What Point- of- Care Tests Do Doctors Want?
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1 What Point- of- Care Tests Do Doctors Want? Jeremy Howick, Caroline Jones, Christopher P Price, Anne>e Plüddemann, Carl Heneghan, Ann Van den Bruel, Ma>hew Thompson Department of Primary Care Health Sciences
2 Context: Transforming the Delivery of Health and Social Care PrevenJng illness and tackling risk factors SupporJng people to live in their own homes Providing high standards of primary care EffecJve use of community health and related social care Acute hospital and care home use only when care not possible in other senngs IntegraJng care around needs of pajents and populajons The Kings Fund 2012
3 Improved inpa-ent care efficiency Use of lower cost treatments Reduc-on in adverse events and medical errors Reduc-on in preventable readmissions Improved management of complex pa-ents Reduc-on in preventable ER visits and admissions Reduc-on in unnecessary tes-ng and referrals Improved preven-on and early diagnosis Use of lower cost se=ngs and providers Improved linkage to community health Lower total healthcare cost & improved healthcare outcomes Improved prac-ce efficiency Shortell et al 2010
4 Themes of NHS Improvement Programmes 2013 prevenjon, early idenjficajon and care coordinajon. creajng individual care plans community based care models coordinated local health system improving local people s experience of services through the effecjve use of technology needs and wants of local people, and disbanding organisajonal boundaries that get in the way focus on reducing hospital admissions. Integrated Care Pioneers 2013
5 presenta-on history signs symptoms tests
6 tests symptoms presenta-on history signs signs tests symptoms tests
7 PATIENT quesjon??? test decision acjon OUTCOME
8 DiagnosJc Services informing decisions across the care pathway GP OP IP OP GP Screening Diagnosis Treatment (op-misa-on) Monitoring
9 Laboratory Tests Family Physicians Would Use in their offices, if cost effecjve Chemistries HbA1c*** INR*** Microalbumin*** Lipid profiles*** BNP Troponin CK- MB D- dimer Drug screen Uric acid Electrolytes Glucose Haemoglobin/HCT CreaJnine AST HepaJc profile Amylase Lipase ESR CBC TSH Lead Bilirubin Vit B12 Fructosamine hs- CRP ßHCG quanjtajve PSA *** = very popular Infec-ous diseases Bacterial vs viral*** Influenza*** Mononucleosis*** Urine culture HIV RSV Clostridium Difficile Rotovirus Bacterial vaginosis Trichomonas Helicobacter Pylori Chlamydia Gonorrhea Herpes Price and Kricka 2012
10 SystemaJc review of qualitajve studies Data about common POCT devices, inc. horizon scanning Discussion with content experts Piloted with 30 GPs Delivered through Doctors.net
11 Please name up to 5 condijons for which a POCT could help you make a DIAGNOSIS. Please list the condijons irrespecjve of whether or not POCTs currently exist a). (please specify) b). (please specify) c). (please specify) d). (please specify) e). (please specify) I do not believe that POCTs would help me make a diagnosis. Open End. Must select Open End. a) or I do not believe.. ; Open Ends b) to e) are non- mandatory
12 What POCT for diagnosis? What POCT to reduce referrals? What POCT to reduce urgent referrals? What POCT to manage long term conditions? What POCTs are currently used?
13 Sent to 1635 regionally representajve GPs in the UK complete response (68%) Highest ever complejon rate for Doctors.net!
14 Condi-on ICPC code No. % Urinary tract infecjon U70/U Pulmonary embolism / DVT K93/K Diabetes NOS T89/T Acute Cardiac Disease K74/K75/K INR / anjcoagulajon XX Pregnancy XX Anaemia B78/B80/B81/B Heart failure K COPD/Asthma R95/R
15 Point- of- Care TesJng internajonal: could help me make a diagnosis Howick et al 2014
16 Condi-on No. % INR / anjcoagulajon Diabetes NOS COPD/Asthma Acute and Chronic Renal Impairment Lipid disorder Hyper/hypothyroidism Anaemia InfecJon of bone/joint Pulmonary embolism / DVT
17 Condi-on ICPC code No. % Pulmonary embolism / DVT K93/K Acute Cardiac Disease K74/K75/K Diabetes NOS T89/T COPD/Asthma R95/R Heart failure K INR / anjcoagulajon XX Urinary tract infecjon U70/U Cancer XX Acute and Chronic Renal Impairment U28/U
18 Test I would use (%) D-dimer 73 Haemoglobin 72 Troponin 69 BNP 66 Chlamydia 65 CRP 61 Potassium (NB sodium 51%) 61 HbA1c 61 White cell count 60 ESR 58 Gonorrhoea 58 Nose/throat swab for influenza 55 Creatinine 53 Throat swab for Group A Streptococci 53 TSH 53 Quantitative Beta HCG 53 Platelet count 51 Uric Acid 50
19 Characteris-c UK (survey) UK (GMC) Respondent characteris/cs Female 475 (43%) 48% What year did you qualify as a doctor (median) How many hours per week do you work (on average)? 39 Percentage GP partner/principal 711 (64%) Prac/ce characteris/cs Rural 103 (9%) Semi- rural 274 (25%) Suburban Urban 293 (26%) 439 (40%)
20 Characteris-c Distance to nearest hospital (average miles) How long does it take to get a roujne blood test, such as full blood count (average days) UK (survey) 7 1.2
21
22 Get pajent input (focus groups, survey) Conduct preliminary cost- benefit analysis PrioriJze which POCT are most demanded and most likely to improve pajent care (If necessary) develop POCTs Measure health impact of POCT in the senng of a controlled trial
23 Point- of- Care TesJng different senngs: other types of quesjons Strategic planning Commissioning intenjons Reducing risk New markets Quality improvement PaJent expectajons
24 Thank you!
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