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de Vos L, Daniels J, Gebengu A, Mazzola L, Gleeson B, Blümel B, Piton J, Mdingi M, Gigi RMS, Ferreyra C, Klausner JD, Peters RPH. Implementation considerations for a point-of-care Neisseria gonorrhoeae rapid diagnostic test at primary healthcare level in South Africa: a qualitative study. BMC Health Serv Res 2024; 24:43. [PMID: 38195446 PMCID: PMC10777514 DOI: 10.1186/s12913-023-10478-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 12/13/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND South Africa maintains an integrated health system where syndromic management of sexually transmitted infections (STI) is the standard of care. An estimated 2 million cases of Neisseria gonorrhoeae (N. gonorrhoeae) occur in South Africa every year. Point-of-care diagnostic tests (POCT) may address existing STI control limitations such as overtreatment and missed cases. Subsequently, a rapid lateral flow assay with fluorescence-based detection (NG-LFA) with a prototype reader was developed for N. gonorrhoeae detection showing excellent performance and high usability; however, a better understanding is needed for device implementation and integration into clinics. METHODS A qualitative, time-series assessment using 66 in-depth interviews was conducted among 25 trained healthcare workers involved in the implementation of the NG-LFA. Findings were informed by the Normalization Process Theory (NPT) as per relevant contextual (strategic intentions, adaptive execution, and negotiation capacity) and procedural constructs (coherence, cognitive participation, collective action, reflexive monitoring) to examine device implementation within primary healthcare levels. Interviews were audio-recorded, transcribed, and then analyzed using a thematic approach guided by NPT to interpret results. RESULTS Overall, healthcare workers agreed that STI POCT could guide better STI clinical decision-making, with consideration for clinic integration such as space constraints, patient flow, and workload. Perceived NG-LFA benefits included enhanced patient receptivity and STI knowledge. Further, healthcare workers reflected on the suitability of the NG-LFA given current limitations with integrated primary care. Recommendations included sufficient STI education, and appropriate departments for first points of entry for STI screening. CONCLUSIONS The collective action and participation by healthcare workers in the implementation of the NG-LFA revealed adaptive execution within the current facility environment including team compositions, facility-staff receptivity, and STI management experiences. User experiences support future clinic service integration, highlighting the importance of further assessing patient-provider communication for STI care, organizational readiness, and identification of relevant departments for STI screening.
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Affiliation(s)
- Lindsey de Vos
- Research Unit, Foundation for Professional Development, East London, South Africa
| | - Joseph Daniels
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, United States of America.
| | - Avuyonke Gebengu
- Research Unit, Foundation for Professional Development, East London, South Africa
| | | | | | | | | | - Mandisa Mdingi
- Research Unit, Foundation for Professional Development, East London, South Africa
| | - Ranjana M S Gigi
- Research Unit, Foundation for Professional Development, East London, South Africa
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | | | - Jeffrey D Klausner
- Keck School of Medicine, University of Southern California, Los Angeles, United States of America
| | - Remco P H Peters
- Research Unit, Foundation for Professional Development, East London, South Africa.
- Department of Medical Microbiology, University of Pretoria, Pretoria, South Africa.
- Division of Medical Microbiology, University of Cape Town, Cape Town, South Africa.
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Thompson CA, Daffu-O'Reilly A, Willis T, Gordon A, Noakes C, Khaliq K, Farrin A, Kemp A, Hall T, Bojke C, Spilsbury K. 'Smart' BLE wearables for digital contact tracing in care homes during the COVID-19 pandemic-a process evaluation of the CONTACT feasibility study. Implement Sci Commun 2023; 4:155. [PMID: 38049924 PMCID: PMC10694939 DOI: 10.1186/s43058-023-00533-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 11/21/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND Rapid and mass transmission of the SARS-CoV-2 virus amongst vulnerable people led to devastating effects from COVID-19 in care homes. The CONTACT intervention introduced Bluetooth Low Energy 'smart' wearable devices (BLE wearables) as a basis for automated contact tracing in, and feedback on infection risks and patterns to, care homes to try and improve infection prevention and control (IPC). We planned a cluster randomised controlled trial (RCT) of CONTACT. To be feasible, homes had to adopt CONTACT's technology and new ways of working. This paper reports on the process evaluation conducted alongside CONTACT's feasibility study and explains why it lacked the feasibility and acceptability for a definitive RCT. METHODS This mixed method process evaluation used Normalisation Process Theory (NPT) qualitative (interviews, field notes, study case report forms and documents, and observation) and quantitative (survey instruments, counts of activity) data to plan, implement, and analyse the mechanisms, effects, and contextual factors that shaped the feasibility and acceptability of the CONTACT intervention. RESULTS Thirteen themes within four core NPT constructs explained CONTACT's lack of feasibility. Coherence: the home's varied in the scale and extent of commitment and understanding of the technology and study procedures. Leadership credibility was important but compromised by competing priorities. Management and direct care staff saw CONTACT differently. Work to promote (cognitive participation) and enact (collective action) CONTACT was burdensome and failed to be prioritised over competing COVID-19-related demands on time and scarce human and cognitive resources. Ultimately, staff appraisal of the value of CONTACT-generated information and study procedures (reflexivity) was that any utility for IPC was insufficient to outweigh the perceived burden and complexity involved. CONCLUSIONS Despite implementation failure, dismissing BLE wearables' potential for contact tracing is premature. In non-pandemic conditions, with more time, better co-design and integration of theory-driven implementation strategies tailored to care homes' unique contexts, researchers could enhance normalisation in readiness for future pandemic challenges. TRIAL REGISTRATION ISRCTN registration: 11,204,126 registered 17/02/2021.
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Affiliation(s)
- Carl A Thompson
- School of Healthcare, University of Leeds, Leeds, LS2 9JT, UK.
| | | | - Thomas Willis
- Trials Research, Leeds Institute of Clinical, University of Leeds, Leeds, LS2 9JT, UK
| | - Adam Gordon
- Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Derby, DE22 3NE, UK
| | - Catherine Noakes
- School of Civil Engineering, University of Leeds, Leeds, LS2 9JT, UK
| | - Kishwer Khaliq
- School of Civil Engineering, University of Leeds, Leeds, LS2 9JT, UK
| | - Amanda Farrin
- Trials Research, Leeds Institute of Clinical, University of Leeds, Leeds, LS2 9JT, UK
| | - Andrew Kemp
- School of Electronics and Electrical Engineering, University of Leeds, Leeds, LS2 9JT, UK
| | - Tom Hall
- South Tyneside Council, South Shields, NE33 2RL, UK
| | - Chris Bojke
- Academic Unit of Health Economics, School of Medicine, University of Leeds, Leeds, LS2 9JT, UK
| | - Karen Spilsbury
- School of Healthcare, University of Leeds, Leeds, LS2 9JT, UK
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Morgan TL, Pletch J, Faught E, Fortier MS, Gazendam MK, Howse K, Jain R, Lane KN, Maclaren K, McFadden T, Prorok JC, Weston ZJ, Tomasone JR. Developing and testing the usability, acceptability, and future implementation of the Whole Day Matters Tool and User Guide for primary care providers using think-aloud, near-live, and interview procedures. BMC Med Inform Decis Mak 2023; 23:57. [PMID: 37024972 PMCID: PMC10080928 DOI: 10.1186/s12911-023-02147-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 03/15/2023] [Indexed: 04/08/2023] Open
Abstract
BACKGROUND Canada's 24-Hour Movement Guidelines for Adults have shifted the focus from considering movement behaviours (i.e., physical activity, sedentary behaviour, and sleep) separately to a 24-h paradigm, which considers how they are integrated. Accordingly, primary care providers (PCPs) have the opportunity to improve their practice to promote all movement behaviours cohesively. However, PCPs have faced barriers to discussing physical activity alone (e.g., time, competing priorities, inadequate training), leading to low frequency of physical activity discussions. Consequently, discussing three movement behaviours may seem challenging. Tools to facilitate primary care discussions about physical activity have been developed and used; however, few have undergone usability testing and none have integrated all movement behaviours. Following a synthesis of physical activity, sedentary behaviour, and sleep tools for PCPs, we developed the Whole Day Matters Tool and User Guide that incorporate all movement behaviours. The present study aimed to explore PCPs' perceptions on the usability, acceptability, and future implementation of the Whole Day Matters Tool and User Guide to improve their relevancy among PCPs. METHODS Twenty-six PCPs were observed and audio-video recorded while using the Tool and User Guide in a think-aloud procedure, then in a near-live encounter with a mock service-user. A debriefing interview using a guide informed by Normalization Process Theory followed. Recordings were transcribed verbatim and analysed using content analysis and a critical friend to enhance rigour. RESULTS PCPs valued aspects of the Tool and User Guide including their structure, user-friendliness, visual appeal, and multi-behaviour focus and suggested modifications to improve usability and acceptability. Findings are further discussed in the context of Normalization Process Theory and previous literature. CONCLUSIONS The Tool and User Guide were revised, including adding plain language, reordering and renaming sections, reducing text, and clarifying instructions. Results also informed the addition of a Preamble and a Handout for adults accessing care (i.e., patients/clients/service-users) to explain the evidence underpinning the 24-Hour Movement Guidelines for Adults and support a person-centered approach. These four resources (i.e., Tool, User Guide, Preamble, Handout) have since undergone a consensus building process to arrive at their final versions before being disseminated into primary care practice.
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Affiliation(s)
- Tamara L Morgan
- School of Kinesiology and Health Studies, Queen's University, 28 Division Street, Kingston, ON, Canada.
| | - Jensen Pletch
- School of Kinesiology and Health Studies, Queen's University, 28 Division Street, Kingston, ON, Canada
| | - Emma Faught
- School of Medicine, Queen's University, Kingston, ON, Canada
| | | | | | - Kelly Howse
- School of Medicine, Queen's University, Kingston, ON, Canada
| | - Rahul Jain
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Kirstin N Lane
- Canadian Society for Exercise Physiology, Ottawa, ON, Canada
- School of Exercise Science, Physical and Health Education, University of Victoria, Victoria, BC, Canada
| | | | | | | | | | - Jennifer R Tomasone
- School of Kinesiology and Health Studies, Queen's University, 28 Division Street, Kingston, ON, Canada
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Viecelli AK, Duncanson E, Bennett PN, D'Antoine M, Dansie K, Handke W, Tong A, Palmer S, Jesudason S, McDonald S, Morton RL. Perspectives of Patients, Nurses, and Nephrologists About Electronic Symptom Monitoring With Feedback in Hemodialysis Care. Am J Kidney Dis 2022; 80:215-226.e1. [PMID: 35085687 DOI: 10.1053/j.ajkd.2021.12.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 12/03/2021] [Indexed: 01/27/2023]
Abstract
RATIONALE & OBJECTIVE Patients receiving hemodialysis experience high symptom burden and low quality of life (QOL). Electronic patient-reported outcome measures (e-PROMs) monitoring with feedback to clinicians may be an acceptable intervention to improve health-related QOL for patients receiving hemodialysis. This study explored patient and clinician perspectives on e-PROMs monitoring with feedback to clinicians. STUDY DESIGN Qualitative study. SETTING & PARTICIPANTS 41 participants (12 patients, 13 nephrologists, 16 dialysis nurses) who participated in a 6-month feasibility pilot study of adults receiving facility-based hemodialysis across 4 Australian units. The intervention consisted of electronic symptom monitoring with feedback to clinicians, who also received evidence-based symptom management recommendations to improve health-related QOL. ANALYTICAL APPROACH Semistructured interviews and focus group discussions explored the feasibility and acceptability of e-PROMs monitoring with feedback to clinicians. We conducted a thematic analysis of transcripts. RESULTS We identified 4 themes: enabling efficient, systematic, and multidisciplinary patient-centered care; experiencing limited data and options for symptom management; requiring familiarity with technology and processes; and identifying barriers and competing priorities. While insufficient patient engagement, logistic/technical challenges, and delayed symptom feedback emerged as barriers to implementation, active engagement by nurses in encouraging and supporting patients during survey completion and clinicians' prompt action after symptom feedback were considered to be facilitators to implementation. LIMITATIONS Limited generalizability due to inclusion of English-speaking participants only. CONCLUSIONS Patients, nurses, and nephrologists considered e-PROMs monitoring with feedback to clinicians feasible for symptom management in hemodialysis. Clinician engagement, patient support, reliable technology, timely symptom feedback, and interventions to address symptom burden are likely to improve its implementation within research and clinical settings.
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Affiliation(s)
- Andrea K Viecelli
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia; Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Emily Duncanson
- Australia and New Zealand Dialysis and Transplant Registry, South Australian Health and Medical Research Institute, Adelaide, Australia; Central Northern Adelaide Renal and Transplantation Service, Adelaide, Australia
| | - Paul N Bennett
- Clinical & Health Sciences, University of South Australia, Adelaide, Australia; Medical and Clinical Affairs, Satellite Healthcare, San Jose, California
| | - Matilda D'Antoine
- Australia and New Zealand Dialysis and Transplant Registry, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Kathryn Dansie
- Australia and New Zealand Dialysis and Transplant Registry, South Australian Health and Medical Research Institute, Adelaide, Australia
| | | | - Allison Tong
- Centre for Kidney Research, Children's Hospital at Westmead, Westmead, Australia; Sydney School of Public Health, University of Sydney, Sydney, Australia
| | - Suetonia Palmer
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Shilpanjali Jesudason
- Central Northern Adelaide Renal and Transplantation Service, Adelaide, Australia; Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
| | - Stephen McDonald
- Australia and New Zealand Dialysis and Transplant Registry, South Australian Health and Medical Research Institute, Adelaide, Australia; Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
| | - Rachael L Morton
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, Australia.
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May CR, Albers B, Bracher M, Finch TL, Gilbert A, Girling M, Greenwood K, MacFarlane A, Mair FS, May CM, Murray E, Potthoff S, Rapley T. Translational framework for implementation evaluation and research: a normalisation process theory coding manual for qualitative research and instrument development. Implement Sci 2022; 17:19. [PMID: 35193611 PMCID: PMC8861599 DOI: 10.1186/s13012-022-01191-x] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 01/18/2022] [Indexed: 04/03/2023] Open
Abstract
Background Normalisation Process Theory (NPT) is frequently used to inform qualitative research that aims to explain and evaluate processes that shape late-stage translation of innovations in the organisation and delivery of healthcare. A coding manual for qualitative researchers using NPT will facilitate transparent data analysis processes and will also reduce the cognitive and practical burden on researchers. Objectives (a) To simplify the theory for the user. (b) To describe the purposes, methods of development, and potential application of a coding manual that translates normalisation process theory (NPT) into an easily usable framework for qualitative analysis. (c) To present an NPT coding manual that is ready for use. Method Qualitative content analysis of papers and chapters that developed normalisation process theory, selection and structuring of theory constructs, and testing constructs against interview data and published empirical studies using NPT. Results A coding manual for NPT was developed. It consists of 12 primary NPT constructs and conforms to the Context-Mechanism-Outcome configuration of realist evaluation studies. Contexts are defined as settings in which implementation work is done, in which strategic intentions, adaptive execution, negotiating capability, and reframing organisational logics are enacted. Mechanisms are defined as the work that people do when they participate in implementation processes and include coherence-building, cognitive participation, collective action, and reflexive monitoring. Outcomes are defined as effects that make visible how things change as implementation processes proceed and include intervention mobilisation, normative restructuring, relational restructuring, and sustainment. Conclusion The coding manual is ready to use and performs three important tasks. It consolidates several iterations of theory development, makes the application of NPT simpler for the user, and links NPT constructs to realist evaluation methods. The coding manual forms the core of a translational framework for implementation research and evaluation. Supplementary Information The online version contains supplementary material available at 10.1186/s13012-022-01191-x.
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May CR, Albers B, Bracher M, Finch TL, Gilbert A, Girling M, Greenwood K, MacFarlane A, Mair FS, May CM, Murray E, Potthoff S, Rapley T. Translational framework for implementation evaluation and research: a normalisation process theory coding manual for qualitative research and instrument development. Implement Sci 2022. [PMID: 35193611 DOI: 10.1186/s13012-022-01191-x.pmid:35193611;pmcid:pmc8861599] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2023] Open
Abstract
BACKGROUND Normalisation Process Theory (NPT) is frequently used to inform qualitative research that aims to explain and evaluate processes that shape late-stage translation of innovations in the organisation and delivery of healthcare. A coding manual for qualitative researchers using NPT will facilitate transparent data analysis processes and will also reduce the cognitive and practical burden on researchers. OBJECTIVES (a) To simplify the theory for the user. (b) To describe the purposes, methods of development, and potential application of a coding manual that translates normalisation process theory (NPT) into an easily usable framework for qualitative analysis. (c) To present an NPT coding manual that is ready for use. METHOD Qualitative content analysis of papers and chapters that developed normalisation process theory, selection and structuring of theory constructs, and testing constructs against interview data and published empirical studies using NPT. RESULTS A coding manual for NPT was developed. It consists of 12 primary NPT constructs and conforms to the Context-Mechanism-Outcome configuration of realist evaluation studies. Contexts are defined as settings in which implementation work is done, in which strategic intentions, adaptive execution, negotiating capability, and reframing organisational logics are enacted. Mechanisms are defined as the work that people do when they participate in implementation processes and include coherence-building, cognitive participation, collective action, and reflexive monitoring. Outcomes are defined as effects that make visible how things change as implementation processes proceed and include intervention mobilisation, normative restructuring, relational restructuring, and sustainment. CONCLUSION The coding manual is ready to use and performs three important tasks. It consolidates several iterations of theory development, makes the application of NPT simpler for the user, and links NPT constructs to realist evaluation methods. The coding manual forms the core of a translational framework for implementation research and evaluation.
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Affiliation(s)
- Carl R May
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine & NIHR North Thames ARC, London, UK.
| | - Bianca Albers
- Institute for Implementation Science in Healthcare, Zurich, Switzerland
| | - Mike Bracher
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Tracy L Finch
- Department of Nursing, Midwifery & Health, Northumbria University & NIHR ARC North East-North Cumbria, Newcastle, UK
| | - Anthony Gilbert
- Royal National Orthopaedic Hospital, London & NIHR North Thames ARC, London, UK
| | - Melissa Girling
- Department of Nursing, Midwifery & Health, Northumbria University & NIHR ARC North East-North Cumbria, Newcastle, UK
| | | | - Anne MacFarlane
- School of Medicine and Health Research Institute, University of Limerick, Limerick, Ireland
| | - Frances S Mair
- Institute of Health and Wellbeing, Glasgow University, Glasgow, UK
| | | | - Elizabeth Murray
- Research Department of Primary Care and Population Health, University College London & NIHR North Thames ARC, London, UK
| | - Sebastian Potthoff
- Department of Social Work, Education and Community Wellbeing, Northumbria University & NIHR ARC North East- North Cumbria, Newcastle, UK
| | - Tim Rapley
- Department of Social Work, Education and Community Wellbeing, Northumbria University & NIHR ARC North East- North Cumbria, Newcastle, UK
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Clinician perspectives on having point of care tests made available to them during out of hours home visiting. BMC FAMILY PRACTICE 2021; 22:246. [PMID: 34911451 PMCID: PMC8675461 DOI: 10.1186/s12875-021-01571-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 09/29/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Little is known about clinicians' perspectives on the use of point of care (POC) tests in assessment of acute illness during primary care out of hours (OOH) care. During a service improvement project, POC tests (including creatinine, electrolytes, haemoglobin and lactate) were made available to clinicians undertaking OOH home visits, with the clinicians allowed absolute discretion about when and whether they used them. METHOD To explore clinicians' perspectives on having POC tests available during OOH home visits, we undertook a qualitative study with clinicians working in Oxfordshire OOH home visiting teams. We conducted 19 Semi-structured interviews with clinicians working in OOH, including those who had and had not used the POC tests available to them. To explore evolving perspectives over time, including experience and exposure to POC tests, we offered clinicians the opportunity to be interviewed twice throughout the study period. Our sample included 7 GPs (4 interviewed once, 3 interviewed twice - earlier and later during the study), 6 emergency practitioners (EPs) including advanced nurse practitioners and paramedics, 1 Healthcare Assistant, and 2 ambulatory care physicians. Interviews were audio-recorded, transcribed verbatim and analysed thematically. RESULTS The clinicians reflected on their decision-making to use (or not use) POC tests, including considering which clinical scenarios were "appropriate" and balancing the resources and time taken to do POC tests against what were perceived as likely benefits. The challenges of using the equipment in patients' homes was a potential barrier, though could become easier with familiarity and experience. Clinicians who had used POC tests described benefits, including planning onward care trajectories, and facilitating communication, both between professionals and with patients and their families. CONCLUSION Clinicians described a discriminatory approach to using POC tests, considering carefully in which situations they were likely to add value to clinical decision-making.
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Rasti R, Brännström J, Mårtensson A, Zenk I, Gantelius J, Gaudenzi G, Alvesson HM, Alfvén T. Point-of-care testing in a high-income country paediatric emergency department: a qualitative study in Sweden. BMJ Open 2021; 11:e054234. [PMID: 34824122 PMCID: PMC8627407 DOI: 10.1136/bmjopen-2021-054234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 11/05/2021] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES In 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 greater laboratory accessibility. Although also part of the clinical routine in HICs, clinician perceptions of the utility of POCTs are relatively unknown in such settings as compared with others. In a Swedish paediatric emergency department (PED) where POCT use is routine, we aimed to characterise healthcare providers' perspectives on the clinical utility of POCTs and explore their implementation in the local setting; to discuss and compare such perspectives, to those reported in other settings; and finally, to gather requests for ideal novel POCTs. DESIGN Qualitative focus group discussions study. A data-driven content analysis approach was used for analysis. SETTING The PED of a secondary paediatric hospital in Stockholm, Sweden. PARTICIPANTS Twenty-four healthcare providers clinically active at the PED were enrolled in six focus groups. RESULTS A range of POCTs was routinely used. The emerging theme Utility of our POCT use is double-edged illustrated the perceived utility of POCTs. While POCT services were considered to have clinical and social value, the local routine for their use was named to distract clinicians from the care for patients. Requests were made for ideal POCTs and their implementation. CONCLUSION Despite 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.
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Affiliation(s)
- Reza Rasti
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Paediatric Rheumatology Unit, Karolinska University Hospital, Stockholm, Sweden
- Paediatric Immuno-psychiatry Unit, CAP Research Centre, Stockholm Healthcare Services, Stockholm, Sweden
| | - Johanna Brännström
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Andreas Mårtensson
- Department of Women's and Children's Health, International Maternal and Child Health, Uppsala University, Uppsala, Sweden
| | - Ingela Zenk
- Sachs' Children and Youth Hospital, South General Hospital, Stockholm, Sweden
| | - Jesper Gantelius
- Division of Nanobiotechnology, Department of Protein Science, KTH Royal Institute of Technology, Science for Life Laboratory, Stockholm, Sweden
| | - Giulia Gaudenzi
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Division of Nanobiotechnology, Department of Protein Science, KTH Royal Institute of Technology, Science for Life Laboratory, Stockholm, Sweden
| | | | - Tobias Alfvén
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Sachs' Children and Youth Hospital, South General Hospital, Stockholm, Sweden
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Li E, Dewez JE, Luu Q, Emonts M, Maconochie I, Nijman R, Yeung S. Role of point-of-care tests in the management of febrile children: a qualitative study of hospital-based doctors and nurses in England. BMJ Open 2021; 11:e044510. [PMID: 33972339 PMCID: PMC8112413 DOI: 10.1136/bmjopen-2020-044510] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 03/30/2021] [Accepted: 03/30/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES The use of rapid point-of-care tests (POCTs) has been advocated for improving patient management and outcomes and for optimising antibiotic prescribing. However, few studies have explored healthcare workers' views about their use in febrile children. The aim of this study was to explore the perceptions of hospital-based doctors and nurses regarding the use of POCTs in England. STUDY DESIGN Qualitative in-depth interviews with purposively selected hospital doctors and nurses. Data were analysed thematically. SETTING Two university teaching hospitals in London and Newcastle. PARTICIPANTS 24 participants (paediatricians, emergency department doctors, trainee paediatricians and nurses). RESULTS There were diverse views about the use of POCTs in febrile children. The reported advantages included their ease of use and the rapid availability of results. They were seen to contribute to faster clinical decision-making; the targeting of antibiotic use; improvements in patient care, flow and monitoring; cohorting (ie, the physical clustering of hospitalised patients with the same infection to limit spread) and enhancing communication with parents. These advantages were less evident when the turnaround for results of laboratory tests was 1-2 hours. Factors such as clinical experience and specialty, as well as the availability of guidelines recommending POCT use, were also perceived as influential. However, in addition to their perceived inaccuracy, participants were concerned about POCTs not resolving diagnostic uncertainty or altering clinical management, leading to a commonly expressed preference for relying on clinical skills rather than test results solely. CONCLUSION In this study conducted at two university teaching hospitals in England, participants expressed mixed opinions about the utility of current POCTs in the management of febrile children. Understanding the current clinical decision-making process and the specific needs and preferences of clinicians in different settings will be critical in ensuring the optimal design and deployment of current and future tests.
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Affiliation(s)
- Edmond Li
- Clinical Research Department, Faculty of Infectious and Tropical Disease, London School of Hygiene and Tropical Medicine, London, UK
- Patient Safety Translational Research Centre, Institute of Global Health Innovation, Department of Surgery & Cancer, Imperial College, London, UK
| | - Juan Emmanuel Dewez
- Clinical Research Department, Faculty of Infectious and Tropical Disease, London School of Hygiene and Tropical Medicine, London, UK
| | - Queena Luu
- Clinical Research Department, Faculty of Infectious and Tropical Disease, London School of Hygiene and Tropical Medicine, London, UK
| | - Marieke Emonts
- Department of Paediatric Immunology, Infectious Diseases & Allergy, Great North Children's Hospital, Newcastle upon Tyne, UK
| | - Ian Maconochie
- Paediatric Emergency Department, St Mary's Hospital Imperial College Healthcare NHS Trust, London, UK
| | - Ruud Nijman
- Section of Paediatric Infectious Diseases, Faculty of Medicine, Imperial College London, London, UK
| | - Shunmay Yeung
- Clinical Research Department, Faculty of Infectious and Tropical Disease, London School of Hygiene and Tropical Medicine, London, UK
- Department of Paediatric Infectious Disease, St Mary's Hospital Imperial College Healthcare NHS Trust, London, UK
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Butler J, de Cassan S, Turner P, Lennox B, Hayward G, Glogowska M. Mental healthcare clinician engagement with point of care testing; a qualitative study. BMC Psychiatry 2021; 21:73. [PMID: 33541304 PMCID: PMC7863427 DOI: 10.1186/s12888-021-03067-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 01/25/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Point of Care Testing (POCT) is being increasingly used to augment the delivery of physical health care in a variety of settings, but their use in mental health has been limited. Research into understanding the barriers faced for successful implementation of POCT in these settings is lacking. We aimed to identify factors affecting engagement and implementation of POCT within mental health teams by exploring the attitudes to POCT, and the perceived impact POCT has on the practice of mental healthcare clinicians. METHODS Alongside a study evaluating the impact of a point of care device in Community Mental Health Teams (CMHTs), qualitative interviews were carried out with CMHT clinicians using POCT as part of annual physical checks for patients with severe and enduring mental illness. Data were collected using semi-structured interviews and analysed using thematic analysis. RESULTS Fifteen clinicians were interviewed across a range of professional backgrounds. Clinicians identified usability of the technology, positive impact on their patient's experience and improved self-efficacy as drivers for successful implementation of POCT into their clinical practice. Issues with device functioning and the potential for a negative effect on the therapeutic relationship with their patients were identified as barriers. Level of physical heath training was not found to be a barrier by mental health professionals to using POCT. CONCLUSIONS Understanding barriers and drivers for engagement is important to allow co-production of POCT and guidelines to facilitate introduction of POCT into routine clinical practice.
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Affiliation(s)
- Joseph Butler
- Foundation Year 3 Physical Health Care, Department of Psychiatry, University of Oxford, Oxford, UK
| | - Simone de Cassan
- Core trainee Psychiatry, Oxford Health NHS Foundation Trust, Oxford, UK
| | - Phil Turner
- NIHR Community Healthcare MIC, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Belinda Lennox
- Oxford Health NHS Foundation Trust, UK and Professor of Psychiatry, Department of Psychiatry, University of Oxford, Oxford, UK
| | - Gail Hayward
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Margaret Glogowska
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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11
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Andryukov BG, Lyapun IN, Bynina MP, Matosova EV. Simplified formats of modern biosensors: 60 years of using immunochromatographic test systems in laboratory diagnostics. Klin Lab Diagn 2021; 65:611-618. [PMID: 33245650 DOI: 10.18821/0869-2084-2020-65-10-611-618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Immunochromatographic test systems known to foreign laboratory diagnostic experts as lateral flow immunoassay (LFIA) are simplified tape formats of modern biosensors. For 60 years, they have been widely used for the rapid detection of target molecules (ligands) in biosubstrates and the diagnosis of many diseases and conditions. The growing popularity of these test systems for providing medical care or diagnostics in developing countries, medical facilities, in emergency situations, as well as for individual home use by patients while monitoring their health are the main factors contributing to the continuous development and improvement of these methods, the emergence of a new generation of formats. The attractiveness and popularity of these fast, easy-to-use, inexpensive and portable diagnostic tools is associated primarily with their high analytical sensitivity and specificity, as well as the ease of interpretation of the results. These qualities have passed the test of time, and today LFIA test systems are fully consistent with the modern world concept of «point-of-care testing», finding wide application not only in medicine, but also in ecology, veterinary medicine, and agriculture. This review will highlight the modern principles of designing the most widely used formats of immunochromatographic test systems for clinical laboratory diagnostics, summarize the main advantages and disadvantages of the method, as well as current achievements and prospects of LFIA technology. Modern innovations aimed at improving the analytical characteristics of LFIA technology are interesting, promising and can bring additional benefits to immunochromatographic platforms that have gained popularity and attractiveness for six decades.
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Affiliation(s)
- Boris Georgievich Andryukov
- Somov Research Institute of Epidemiology and Microbiology, Russian Ministry of Education and Science.,Far Eastern Federal University of the Ministry of Education and Science of Russia
| | - I N Lyapun
- Somov Research Institute of Epidemiology and Microbiology, Russian Ministry of Education and Science
| | - M P Bynina
- Somov Research Institute of Epidemiology and Microbiology, Russian Ministry of Education and Science
| | - E V Matosova
- Somov Research Institute of Epidemiology and Microbiology, Russian Ministry of Education and Science
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12
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Duncanson E, Bennett PN, Viecelli A, Dansie K, Handke W, Tong A, Palmer S, Jesudason S, McDonald SP, Morton RL. Feasibility and acceptability of e-PROMs data capture and feedback among patients receiving haemodialysis in the Symptom monitoring WIth Feedback Trial (SWIFT) pilot: protocol for a qualitative study in Australia. BMJ Open 2020; 10:e039014. [PMID: 33158824 PMCID: PMC7651719 DOI: 10.1136/bmjopen-2020-039014] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION People receiving haemodialysis experience a high symptom burden and impaired quality of life. The use of patient-reported outcome measures (PROMs) is increasing in nephrology care, however their acceptability, utility and impacts are not well understood. METHODS AND ANALYSIS We describe a protocol for a qualitative study to evaluate the feasibility and acceptability of electronic-PROMs (e-PROMs) data capture and feedback in haemodialysis following the pilot Symptom monitoring WIth Feedback Trial (SWIFT). SWIFT involves linkage of e-PROMs data, including symptoms and health-related quality of life, to the Australia and New Zealand Dialysis and Transplant Registry with feedback to patients' treating nephrologists and nurse unit managers. Focus groups and semistructured interviews will be conducted with nephrologists (n=15), dialysis nurses (n=24) and patients receiving haemodialysis (n=24) from six dialysis units in Australia. Question topics will include the technical and clinical feasibility and acceptability of e-PROMs reporting and feedback (including the barriers and enablers to uptake) and perceived impact on patient care and outcomes. Transcripts will be analysed thematically and guided by Normalisation Process Theory. ETHICS AND DISSEMINATION Ethics approval was obtained from the relevant hospital Human Research Ethics Committees (HREC/18/CALHN/481; HREC/MML/54599). The findings from the SWIFT pilot and qualitative evaluation will inform the implementation of the SWIFT main trial, and more broadly, the use of e-PROMs in clinical settings and registries. TRIAL REGISTRATION NUMBER ANZCTRN12618001976279.
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Affiliation(s)
- Emily Duncanson
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Paul N Bennett
- Faculty of Health Medicine Nursing and Behavioural Sciences, Deakin University, Burwood, Victoria, Australia
| | - Andrea Viecelli
- School of Medicine, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Kathryn Dansie
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - William Handke
- Consumer representative, Private citizen, Canberra, ACT, Australia
| | - Allison Tong
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Suetonia Palmer
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Shilpanjali Jesudason
- Central and Northern Adelaide Renal and Transplantation Services (CNARTS), Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Stephen P McDonald
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- Central and Northern Adelaide Renal and Transplantation Services (CNARTS), Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Rachael L Morton
- NHMRC Clinical Trials Centre, The University of Sydney, Camperdown, New South Wales, Australia
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13
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Andryukov BG. Six decades of lateral flow immunoassay: from determining metabolic markers to diagnosing COVID-19. AIMS Microbiol 2020; 6:280-304. [PMID: 33134745 PMCID: PMC7595842 DOI: 10.3934/microbiol.2020018] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 08/20/2020] [Indexed: 01/10/2023] Open
Abstract
Technologies based on lateral flow immunoassay (LFIA), known in some countries of the world as immunochromatographic tests, have been successfully used for the last six decades in diagnostics of many diseases and conditions as they allow rapid detection of molecular ligands in biosubstrates. The popularity of these diagnostic platforms is constantly increasing in healthcare facilities, particularly those facing limited budgets and time, as well as in household use for individual health monitoring. The advantages of these low-cost devices over modern laboratory-based analyzers come from their availability, opportunity of rapid detection, and ease of use. The attractiveness of these portable diagnostic tools is associated primarily with their high analytical sensitivity and specificity, as well as with the easy visual readout of results. These qualities explain the growing popularity of LFIA in developing countries, when applied at small hospitals, in emergency situations where screening and monitoring health condition is crucially important, and as well as for self-testing of patients. These tools have passed the test of time, and now LFIA test systems are fully consistent with the world's modern concept of ‘point-of-care testing’, finding a wide range of applications not only in human medicine, but also in ecology, veterinary medicine, and agriculture. The extensive opportunities provided by LFIA contribute to the continuous development and improvement of this technology and to the creation of new-generation formats. This review will highlight the modern principles of design of the most widely used formats of test-systems for clinical laboratory diagnostics, summarize the main advantages and disadvantages of the method, as well as the current achievements and prospects of the LFIA technology. The latest innovations are aimed at improving the analytical performance of LFIA platforms for the diagnosis of bacterial and viral infections, including COVID-19.
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Affiliation(s)
- Boris G Andryukov
- Somov Research Institute of Epidemiology and Microbiology, Vladivostok, Russian Federation.,Far Eastern Federal University (FEFU), Vladivostok, Russian Federation
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14
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Fanshawe TR, Glogowska M, Edwards G, Turner PJ, Smith I, Steele R, Croxson C, Bowen JST, Hayward GN. Pre-analytical error for three point of care venous blood testing platforms in acute ambulatory settings: A mixed methods service evaluation. PLoS One 2020; 15:e0228687. [PMID: 32012203 PMCID: PMC6996845 DOI: 10.1371/journal.pone.0228687] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 01/20/2020] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Point of care blood testing to aid diagnosis is becoming increasingly common in acute ambulatory settings and enables timely investigation of a range of diagnostic markers. However, this testing allows scope for errors in the pre-analytical phase, which depends on the operator handling and transferring specimens correctly. The extent and nature of these pre-analytical errors in clinical settings has not been widely reported. METHODS We carried out a convergent parallel mixed-methods service evaluation to investigate pre-analytical errors leading to a machine error reports in a large acute hospital trust in the UK. The quantitative component comprised a retrospective analysis of all recorded error codes from Abbott Point of Care i-STAT 1, i-STAT Alinity and Abbott Rapid Diagnostics Afinion devices to summarise the error frequencies and reasons for error, focusing on those attributable to the operator. The qualitative component included a prospective ethnographic study and a secondary analysis of an existing ethnographic dataset, based in hospital-based ambulatory care and community ambulatory care respectively. RESULTS The i-STAT had the highest usage (113,266 tests, January 2016-December 2018). As a percentage of all tests attempted, its device-recorded overall error rate was 6.8% (95% confidence interval 6.6% to 6.9%), and in the period when reliable data could be obtained, the operator-attributable error rate was 2.3% (2.2% to 2.4%). Staff identified that the most difficult step was the filling of cartridges, but that this could be improved through practice, with a perception that cartridge wastage through errors was rare. CONCLUSIONS In the observed settings, the rate of errors attributable to operators of the primary point of care device was less than 1 in 40. In some cases, errors may lead to a small increase in resource use or time required so adequate staff training is necessary to prevent adverse impact on patient care.
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Affiliation(s)
- Thomas R. Fanshawe
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Margaret Glogowska
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - George Edwards
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Philip J. Turner
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Ian Smith
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Rosie Steele
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | | | - Jordan S. T. Bowen
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Gail N. Hayward
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
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15
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Hayward G, Dixon S, Garland S, Glogowska M, Hunt H, Lasserson D. Point-of-care blood tests during home visits by out-of-hours primary care clinicians; a mixed methods evaluation of a service improvement. BMJ Open 2020; 10:e033428. [PMID: 31948989 PMCID: PMC7045021 DOI: 10.1136/bmjopen-2019-033428] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES We aimed to evaluate test usage and patient and clinician experience following the introduction of point-of-care (POC) blood tests into a primary care out-of-hours service. DESIGN A mixed methods service evaluation comprising quantitative records of the clinical contexts of tests taken and qualitative interviews with clinicians. Research permissions and governance were obtained for patient interviews. SETTING Out-of-hours primary care. PARTICIPANTS All patients requiring home visits from the service during the implementation period. INTERVENTIONS The i-STAT POC blood test platform was introduced to two bases providing home visits for a period of 8 months. Venous blood samples were used and two cartridges were available. The CHEM8 cartridge measures sodium, potassium, chloride, total carbon dioxide (TCO2), anion gap, ionised calcium, glucose, urea, creatinine, haematocrit and haemoglobin. The CG4 cartridge measures lactate, pH, PaO2 and PCO2, TCO2, bicarbonate, base excess and oxygen saturation. PRIMARY AND SECONDARY OUTCOME MEASURES The proportion of home visits where tests were taken, the clinical contexts of those tests, the extent to which clinicians felt the tests had influenced their decisions, time taken to perform the test and problems encountered. Clinician and patient experiences of using POC tests. RESULTS i-STAT POC tests were infrequently used, with successful tests taken at just 47 contacts over 8 months of implementation. The patients interviewed felt that testing had been beneficial for their care. Clinician interviews suggested barriers to POC tests, including practical challenges, concerns about time, doubt over whether they would improve clinical decision making and concern about increased medicolegal risk. Suggestions for improving adoption included sharing learning, adopting a whole team approach and developing protocols for usage. CONCLUSIONS POC tests were not successfully adopted by an out-of-hours home visiting service in Oxfordshire. While some clinicians felt they could not add value, in other cases they resulted in improved patient experience. Adoption could be promoted by improving technical, team and education factors.
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Affiliation(s)
- Gail Hayward
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Sharon Dixon
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Sophie Garland
- Urgent and Ambulatory Care, Oxford Health NHS Foundation Trust, Oxford, Oxfordshire, UK
| | - Margaret Glogowska
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Helen Hunt
- Urgent and Ambulatory Care, Oxford Health NHS Foundation Trust, Oxford, Oxfordshire, UK
| | - Daniel Lasserson
- Institute of Applied Health Research, University of Birmingham, Birmingham, West Midlands, UK
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16
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van Hecke O, Butler C, Mendelson M, Tonkin-Crine S. Introducing new point-of-care tests for common infections in publicly funded clinics in South Africa: a qualitative study with primary care clinicians. BMJ Open 2019; 9:e029260. [PMID: 31772084 PMCID: PMC6887073 DOI: 10.1136/bmjopen-2019-029260] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
UNLABELLED Broad-spectrum antibiotics are routinely prescribed empirically in the resource-poor settings for suspected acute common infections, which drive antimicrobial resistance. Point-of-care testing (POCT) might increase the appropriateness of decisions about whether and which antibiotic to prescribe, but implementation will be most effective if clinician's perspectives are taken into account. OBJECTIVES To explore the perceptions of South African primary care clinicians working in publicly funded clinics about: making antibiotic prescribing decisions for two common infection syndromes (acute cough, urinary tract infection); their experiences of existing POCTs; their perceptions of the barriers and opportunities for introducing (hypothetical) new POCTs. DESIGN, METHOD, PARTICIPANTS, SETTING Qualitative semistructured interviews with 23 primary care clinicians (nurses and doctors) at publicly funded clinics in the Western Cape Metro district, South Africa. Data were analysed using thematic analysis. RESULTS Clinicians reported that their antibiotic prescribing decisions were influenced by their clinical assessment, patient comorbidities, social factors (eg, access to care) and perceived patient expectations. Their experiences with currently available POCTs were largely positive, and they were optimistic about the potential for new POCTs to: support evidence-based prescribing decisions that might reduce unnecessary antibiotic prescriptions; reduce the need for further investigations; support effective communication with patients, especially when antibiotics were unlikely to be of benefit. Resources and workflow disruption were seen as the main barriers to uptake into routine care. CONCLUSIONS Clinicians working in publicly funded clinics in the Western Cape Metro of South Africa saw POCTs as potentially useful for positively addressing both clinical and social drivers of the overprescribing of broad-spectrum antibiotics, but were concerned about the resource implications and disruption of existing patient workflows.
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Affiliation(s)
- Oliver van Hecke
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Chris Butler
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- NIHR Health Protection Research Unit in Healthcare-Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford, UK
| | - Marc Mendelson
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, UK
| | - Sarah Tonkin-Crine
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- NIHR Health Protection Research Unit in Healthcare-Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford, UK
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17
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Mishuris RG, Palmisano J, McCullagh L, Hess R, Feldstein DA, Smith PD, McGinn T, Mann DM. Using normalisation process theory to understand workflow implications of decision support implementation across diverse primary care settings. BMJ Health Care Inform 2019; 26:bmjhci-2019-100088. [PMID: 31630113 PMCID: PMC7062348 DOI: 10.1136/bmjhci-2019-100088] [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: 06/26/2019] [Revised: 09/26/2019] [Accepted: 09/30/2019] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Effective implementation of technologies into clinical workflow is hampered by lack of integration into daily activities. Normalisation process theory (NPT) can be used to describe the kinds of 'work' necessary to implement and embed complex new practices. We determined the suitability of NPT to assess the facilitators, barriers and 'work' of implementation of two clinical decision support (CDS) tools across diverse care settings. METHODS We conducted baseline and 6-month follow-up quantitative surveys of clinic leadership at two academic institutions' primary care clinics randomised to the intervention arm of a larger study. The survey was adapted from the NPT toolkit, analysing four implementation domains: sense-making, participation, action, monitoring. Domains were summarised among completed responses (n=60) and examined by role, institution, and time. RESULTS The median score for each NPT domain was the same across roles and institutions at baseline, and decreased at 6 months. At 6 months, clinic managers' participation domain (p=0.003), and all domains for medical directors (p<0.003) declined. At 6 months, the action domain decreased among Utah respondents (p=0.03), and all domains decreased among Wisconsin respondents (p≤0.008). CONCLUSIONS This study employed NPT to longitudinally assess the implementation barriers of new CDS. The consistency of results across participant roles suggests similarities in the work each role took on during implementation. The decline in engagement over time suggests the need for more frequent contact to maintain momentum. Using NPT to evaluate this implementation provides insight into domains which can be addressed with participants to improve success of new electronic health record technologies. TRIAL REGISTRATION NUMBER NCT02534987.
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Affiliation(s)
| | - Joseph Palmisano
- Boston University School of Medicine, Boston, Massachusetts, USA
| | - Lauren McCullagh
- Northwell Health and Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Rachel Hess
- University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - David A Feldstein
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Paul D Smith
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Thomas McGinn
- Northwell Health and Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Devin M Mann
- New York University School of Medicine, New York City, New York, USA
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18
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Fanshawe TR, Ordóñez-Mena JM, Turner PJ, Bruel AVD, Shine B, Hayward GN. Frequencies and patterns of laboratory test requests from general practice: a service evaluation to inform point-of-care testing. J Clin Pathol 2018; 71:1065-1071. [PMID: 30228215 DOI: 10.1136/jclinpath-2018-205242] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 07/30/2018] [Accepted: 08/03/2018] [Indexed: 12/13/2022]
Abstract
AIMS The demand for test requests from general practice to laboratory services remains high. Tests performed at the point of care could reduce turnaround time and speed up clinical decision making. Replicating laboratory testing in the community would require panels of tests to be performed simultaneously, which is now approaching technological feasibility. We assessed frequencies and combinations of test requests from community settings to inform the potential future development of multiplex point-of-care panels. METHODS We assessed all laboratory test requests made from general practice in Oxfordshire, UK, from January 2014 to March 2017. We summarised test request frequency overall and in combination, using heatmaps and hierarchical cluster analysis. Results are also presented by age/sex subgroups. We further assessed patterns of tests requested within 7 and 14 days after an initial test request. RESULTS 11 763 473 test requests were made for 413 073 individuals (28% age >65). Of more than 500 test types, 62 were requested at least 5000 times, most commonly renal function tests (approximately 296 000/year), full blood count (278 000/year) and liver function tests (237 000/year). Cluster analysis additionally identified a clear grouping of tests commonly used to investigate anaemia. Follow-up test frequency was much lower than the frequency of multiple tests ordered at initial presentation. CONCLUSIONS The current high volume of single and combination test requests highlights an opportunity for reliable multiplex point-of-care panels to cover a core set of frequently requested tests. The impact on test use of introducing such panels to general practice requires additional research.
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Affiliation(s)
- Thomas R Fanshawe
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford , UK
| | - José M Ordóñez-Mena
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford , UK
| | - Philip J Turner
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford , UK
| | - Ann Van den Bruel
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford , UK.,Academic Centre of General Practice, University of Leuven, Leuven, Belgium
| | - Brian Shine
- Clinical Biochemistry, John Radcliffe Hospital, Oxford , UK
| | - Gail N Hayward
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford , UK
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19
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Desveaux L, Mitchell JI, Shaw J, Ivers NM. Understanding the impact of accreditation on quality in healthcare: A grounded theory approach. Int J Qual Health Care 2018; 29:941-947. [PMID: 29045664 DOI: 10.1093/intqhc/mzx136] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2017] [Indexed: 11/15/2022] Open
Abstract
Objective To explore how organizations respond to and interact with the accreditation process and the actual and potential mechanisms through which accreditation may influence quality. Design Qualitative grounded theory study. Setting Organizations who had participated in Accreditation Canada's Qmentum program during January 2014-June 2016. Participants Individuals who had coordinated the accreditation process or were involved in managing or promoting quality. Results The accreditation process is largely viewed as a quality assurance process, which often feeds in to quality improvement activities if the feedback aligns with organizational priorities. Three key stages are required for accreditation to impact quality: coherence, organizational buy-in and organizational action. These stages map to constructs outlined in Normalization Process Theory. Coherence is established when an organization and its staff perceive that accreditation aligns with the organization's beliefs, context and model of service delivery. Organizational buy-in is established when there is both a conceptual champion and an operational champion, and is influenced by both internal and external contextual factors. Quality improvement action occurs when organizations take purposeful action in response to observations, feedback or self-reflection resulting from the accreditation process. Conclusions The accreditation process has the potential to influence quality through a series of three mechanisms: coherence, organizational buy-in and collective quality improvement action. Internal and external contextual factors, including individual characteristics, influence an organization's experience of accreditation.
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Affiliation(s)
- L Desveaux
- Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, 76 Grenville Ave, Toronto, Ontario, Canada
| | | | - J Shaw
- Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, 76 Grenville Ave, Toronto, Ontario, Canada.,Institute for Health Policy, Management, and Evaluation, University of Toronto, 155 College Street, Toronto, Ontario, Canada
| | - N M Ivers
- Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, 76 Grenville Ave, Toronto, Ontario, Canada.,Institute for Health Policy, Management, and Evaluation, University of Toronto, 155 College Street, Toronto, Ontario, Canada
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20
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May CR, Cummings A, Girling M, Bracher M, Mair FS, May CM, Murray E, Myall M, Rapley T, Finch T. Using Normalization Process Theory in feasibility studies and process evaluations of complex healthcare interventions: a systematic review. Implement Sci 2018; 13:80. [PMID: 29879986 PMCID: PMC5992634 DOI: 10.1186/s13012-018-0758-1] [Citation(s) in RCA: 283] [Impact Index Per Article: 47.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 04/24/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Normalization Process Theory (NPT) identifies, characterises and explains key mechanisms that promote and inhibit the implementation, embedding and integration of new health techniques, technologies and other complex interventions. A large body of literature that employs NPT to inform feasibility studies and process evaluations of complex healthcare interventions has now emerged. The aims of this review were to review this literature; to identify and characterise the uses and limits of NPT in research on the implementation and integration of healthcare interventions; and to explore NPT's contribution to understanding the dynamics of these processes. METHODS A qualitative systematic review was conducted. We searched Web of Science, Scopus and Google Scholar for articles with empirical data in peer-reviewed journals that cited either key papers presenting and developing NPT, or the NPT Online Toolkit ( www.normalizationprocess.org ). We included in the review only articles that used NPT as the primary approach to collection, analysis or reporting of data in studies of the implementation of healthcare techniques, technologies or other interventions. A structured data extraction instrument was used, and data were analysed qualitatively. RESULTS Searches revealed 3322 citations. We show that after eliminating 2337 duplicates and broken or junk URLs, 985 were screened as titles and abstracts. Of these, 101 were excluded because they did not fit the inclusion criteria for the review. This left 884 articles for full-text screening. Of these, 754 did not fit the inclusion criteria for the review. This left 130 papers presenting results from 108 identifiable studies to be included in the review. NPT appears to provide researchers and practitioners with a conceptual vocabulary for rigorous studies of implementation processes. It identifies, characterises and explains empirically identifiable mechanisms that motivate and shape implementation processes. Taken together, these mean that analyses using NPT can effectively assist in the explanation of the success or failure of specific implementation projects. Ten percent of papers included critiques of some aspect of NPT, with those that did mainly focusing on its terminology. However, two studies critiqued NPT emphasis on agency, and one study critiqued NPT for its normative focus. CONCLUSIONS This review demonstrates that researchers found NPT useful and applied it across a wide range of interventions. It has been effectively used to aid intervention development and implementation planning as well as evaluating and understanding implementation processes themselves. In particular, NPT appears to have offered a valuable set of conceptual tools to aid understanding of implementation as a dynamic process.
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Affiliation(s)
- Carl R. May
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Amanda Cummings
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Melissa Girling
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Mike Bracher
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Frances S. Mair
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Christine M. May
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Elizabeth Murray
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Michelle Myall
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Tim Rapley
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Tracy Finch
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
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21
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Jun S, Plint AC, Campbell SM, Curtis S, Sabir K, Newton AS. Point-of-care Cognitive Support Technology in Emergency Departments: A Scoping Review of Technology Acceptance by Clinicians. Acad Emerg Med 2018; 25:494-507. [PMID: 28960689 DOI: 10.1111/acem.13325] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 09/12/2017] [Accepted: 09/23/2017] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Cognitive support technologies that support clinical decisions and practices in the emergency department (ED) have the potential to optimize patient care. However, limited uptake by clinicians can prevent successful implementation. A better understanding of acceptance of these technologies from the clinician perspective is needed. We conducted a scoping review to synthesize diverse, emerging evidence on clinicians' acceptance of point-of-care (POC) cognitive support technology in the ED. METHOD We systematically searched 10 electronic databases and gray literature published from January 2006 to December 2016. Studies of any design assessing an ED-based POC cognitive support technology were considered eligible for inclusion. Studies were required to report outcome data for technology acceptance. Two reviewers independently screened studies for relevance and quality. Study quality was assessed using the Mixed-Methods Appraisal Tool. A descriptive analysis of the features of POC cognitive support technology for each study is presented, illustrating trends in technology development and evaluation. A thematic analysis of clinician, technical, patient, and organizational factors associated with technology acceptance is also presented. RESULTS Of the 1,563 references screened for eligibility, 24 met the inclusion criteria and were included in the review. Most studies were published from 2011 onward (88%), scored high for methodologic quality (79%), and examined POC technologies that were novel and newly introduced into the study setting (63%). Physician use of POC technology was the most commonly studied (67%). Technology acceptance was frequently conceptualized and measured by factors related to clinician attitudes and beliefs. Experience with the technology, intention to use, and actual use were also more common outcome measures of technology acceptance. Across studies, perceived usefulness was the most noteworthy factor impacting technology acceptance, and clinicians generally had positive perceptions of the use of POC cognitive support technology in the ED. However, the actual use of POC cognitive support technology reported by clinicians was low-use, by proportion of patient cases, ranged from 30% to 59%. Of the 24 studies, only two studies investigated acceptance of POC cognitive support technology currently implemented in the ED, offering "real-world" clinical practice data. All other studies focused on acceptance of novel technologies. Technical aspects such as an unfriendly user interface, presentation of redundant or ambiguous information, and required user effort had a negative impact on acceptance. Patient expectations were also found to have a negative impact, while patient safety implications had a positive impact. Institutional support was also reported to impact technology acceptance. CONCLUSIONS Findings from this scoping review suggest that while ED clinicians acknowledge the utility and value of using POC cognitive support technology, actual use of such technology can be low. Further, few studies have evaluated the acceptance and use of POC technologies in routine care. Prospective studies that evaluate how ED clinicians appraise and consider POC technology use in clinical practice are now needed with diverse clinician samples. While this review identified multiple factors contributing to technology acceptance, determining how clinician, technical, patient, and organizational factors mediate or moderate acceptance should also be a priority.
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Affiliation(s)
- Shelly Jun
- Department of Pediatrics University of Alberta Edmonton AlbertaCanada
| | - Amy C. Plint
- Departments of Pediatrics and Emergency Medicine University of Ottawa (ACP) Ottawa OntarioCanada
| | - Sandy M. Campbell
- The John W. Scott Health Sciences Library University of Alberta Edmonton AlbertaCanada
| | - Sarah Curtis
- Department of Pediatrics University of Alberta Edmonton AlbertaCanada
| | - Kyrellos Sabir
- The School of Medicine National University of Ireland Galway (KS) Galway Ireland
| | - Amanda S. Newton
- Department of Pediatrics University of Alberta Edmonton AlbertaCanada
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22
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Van den Bruel A, Hayward G. Diagnostic evidence cooperatives: bridging the valley of death in diagnostics development. Diagn Progn Res 2018; 2:9. [PMID: 31093559 PMCID: PMC6460518 DOI: 10.1186/s41512-018-0030-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 05/15/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Diagnostic tests' impact on patient outcomes and health processes is potentially large, and proper evaluations before widespread adoption are warranted. Such evaluations are challenged by the fact that tests can have multiple purposes, in different clinical pathways, with different roles. BODY The National Institute for Health Research (NIHR) established four Diagnostic Evidence Cooperatives (DEC) in 2013, across England. The aim of these DECs was to facilitate the development and evaluation of clinically relevant in vitro diagnostics, by offering methodological expertise and access to real-life settings for evaluations in patients. In this commentary, we discuss our experience over the past 4 years. CONCLUSION The interaction of industry, researchers, and clinicians has proven to be very worthwhile.
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Affiliation(s)
- Ann Van den Bruel
- 0000 0004 1936 8948grid.4991.5NIHR Diagnostic Evidence Cooperative Oxford, Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, 32 Woodstock Road, Oxford, OX2 6GG UK
- Academic Centre for Primary Care, KU Leuven, Belgium
| | - Gail Hayward
- 0000 0004 1936 8948grid.4991.5NIHR Diagnostic Evidence Cooperative Oxford, Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, 32 Woodstock Road, Oxford, OX2 6GG UK
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23
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Borsci S, Uchegbu I, Buckle P, Ni Z, Walne S, Hanna GB. Designing medical technology for resilience: integrating health economics and human factors approaches. Expert Rev Med Devices 2017; 15:15-26. [PMID: 29243500 DOI: 10.1080/17434440.2018.1418661] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION The slow adoption of innovation into healthcare calls into question the manner of evidence generation for medical technology. This paper identifies potential reasons for this including a lack of attention to human factors, poor evaluation of economic benefits, lack of understanding of the existing healthcare system and a failure to recognise the need to generate resilient products. Areas covered: Recognising a cross-disciplinary need to enhance evidence generation early in a technology's life cycle, the present paper proposes a new approach that integrates human factors and health economic evaluation as part of a wider systems approach to the design of technology. This approach (Human and Economic Resilience Design for Medical Technology or HERD MedTech) supports early stages of product development and is based on the recent experiences of the National Institute for Health Research London Diagnostic Evidence Co-operative in the UK. Expert commentary: HERD MedTech i) proposes a shift from design for usability to design for resilience, ii) aspires to reduce the need for service adaptation to technological constraints iii) ensures value of innovation at the time of product development, and iv) aims to stimulate discussion around the integration of pre- and post-market methods of assessment of medical technology.
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Affiliation(s)
- Simone Borsci
- a Surgery and Cancer , National Institute for Health Research Diagnostic Evidence Cooperative of London, Imperial College London, St Mary's Hospital , London , UK
| | - Ijeoma Uchegbu
- a Surgery and Cancer , National Institute for Health Research Diagnostic Evidence Cooperative of London, Imperial College London, St Mary's Hospital , London , UK
| | - Peter Buckle
- a Surgery and Cancer , National Institute for Health Research Diagnostic Evidence Cooperative of London, Imperial College London, St Mary's Hospital , London , UK
| | - Zhifang Ni
- a Surgery and Cancer , National Institute for Health Research Diagnostic Evidence Cooperative of London, Imperial College London, St Mary's Hospital , London , UK
| | - Simon Walne
- a Surgery and Cancer , National Institute for Health Research Diagnostic Evidence Cooperative of London, Imperial College London, St Mary's Hospital , London , UK
| | - George B Hanna
- a Surgery and Cancer , National Institute for Health Research Diagnostic Evidence Cooperative of London, Imperial College London, St Mary's Hospital , London , UK
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24
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Hirst JA, Stevens RJ, Smith I, James T, Gudgin BC, Farmer AJ. How can point-of-care HbA1c testing be integrated into UK primary care consultations? - A feasibility study. Diabetes Res Clin Pract 2017; 130:113-120. [PMID: 28602811 DOI: 10.1016/j.diabres.2017.05.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 05/11/2017] [Indexed: 12/26/2022]
Abstract
AIMS Point-of-care (POC) HbA1c testing gives a rapid result, allowing testing and treatment decisions to take place in a single appointment. Trials of POC testing have not been shown to improve HbA1c, possibly because of how testing was implemented. This study aimed to identify key components of POC HbA1c testing and determine strategies to optimise implementation in UK primary care. METHODS This cohort feasibility study recruited thirty patients with type 2 diabetes and HbA1c>7.5% (58mmol/mol) into three primary care clinics. Patients' clinical care included two POC HbA1c tests over six months. Data were collected on appointment duration, clinical decisions, technical performance and patient behaviour. RESULTS Fifty-three POC HbA1c consultations took place during the study; clinical decisions were made in 30 consultations. Five POC consultations with a family doctor lasted on average 11min and 48 consultations with nurses took on average 24min. Five POC study visits did not take place in one clinic. POC results were uploaded to hospital records from two clinics. In total, sixty-three POC tests were performed, and there were 11 cartridge failures. No changes in HbA1c or patient behaviour were observed. CONCLUSIONS HbA1c measurement with POC devices can be effectively implemented in primary care. This work has identified when these technologies might work best, as well as potential challenges. The findings can be used to inform the design of a pragmatic trial to implement POC HbA1c testing.
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Affiliation(s)
- J A Hirst
- Nuffield Department of Primary Care Health Science, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, United Kingdom.
| | - R J Stevens
- Nuffield Department of Primary Care Health Science, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, United Kingdom
| | - I Smith
- John Radcliffe Hospital, Headley Way, Headington, Oxford OX3 9DU, United Kingdom
| | - T James
- John Radcliffe Hospital, Headley Way, Headington, Oxford OX3 9DU, United Kingdom
| | - B C Gudgin
- Patient Representative, Oxfordshire, United Kingdom
| | - A J Farmer
- Nuffield Department of Primary Care Health Science, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, United Kingdom
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25
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Bustinduy AL, Jeyaratnam D, Douthwaite S, Tonkin-Crine S, Shaw R, Hyrapetian L, Sevdalis N, Goldenberg S, Adams EJ, Sharland M. Point-of-care tests for infectious diseases: barriers to implementation across three London teaching hospitals. Acta Paediatr 2017; 106:1192-1195. [PMID: 28374509 DOI: 10.1111/apa.13867] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 02/03/2017] [Accepted: 03/30/2017] [Indexed: 12/14/2022]
Affiliation(s)
- Amaya L. Bustinduy
- Paediatric Infectious Diseases Research Group; Infection and Immunity Institute; St George's University of London; London UK
- Clinical Research Department; London School of Hygiene & Tropical Medicine; London UK
| | - Dakshika Jeyaratnam
- Department of Microbiology; King's College Hospital NHS Foundation Trust; London UK
| | - Sam Douthwaite
- Virology Department; Guy's and St Thomas’ NHS trust; London UK
| | - Sarah Tonkin-Crine
- Nuffield Department of Primary Care Health Sciences; University of Oxford; Oxford UK
| | - Rebecca Shaw
- Paediatric Infectious Diseases Research Group; Infection and Immunity Institute; St George's University of London; London UK
| | | | - Nick Sevdalis
- Health Service & Population Research Department; King's College London; London UK
| | - Simon Goldenberg
- Centre for Clinical Infection and Diagnostics Research; King's College; London UK
- Guy's & St Thomas' NHS Foundation Trust; London UK
| | | | - Mike Sharland
- Paediatric Infectious Diseases Research Group; Infection and Immunity Institute; St George's University of London; London UK
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