Near-patient testing for serum cholesterol: attitudes of general practitioners and patients, appropriateness, and costs

Performance evaluation of Barozen Lipid Plus for point-of-care testing of lipid profiles: a method comparison study

BACKGROUND

The quick and easy nature of point-of-care (POC) testing devices allows regular monitoring of serum lipid levels to increase efficiency. The purpose of this study was to assess a POC lipid analyzer, Barozen Lipid Plus (MICO Biomed Co., Ltd.), which uses capillary blood to measure total cholesterol (TC), triglycerides (TGs), and high-density lipoprotein cholesterol (HDL-C).

METHODS

Capillary and venous blood samples were collected from 110 participants at a single center in Korea between June 10 and June 26, 2021. TC, TG, and HDL-C measurements using Barozen Lipid Plus were compared with measurements using our reference device, the Roche-Hitachi Cobas 8000 c702 (Hitachi High-Technologies Corporation). This study followed the guidelines of the Clinical and Laboratory Standards Institute and the Clinical Laboratory Improvement Amendments. We surveyed participants regarding the convenience of the POC device using a questionnaire following the completion of blood collection.

RESULTS

When compared to the reference equipment, the measurements obtained using Barozen Lipid Plus were more than 95% satisfactory within TC±10%, TG±25%, and HDL-C±30%. The coefficient of variation in the repeatability testing was within 5% for TC, 5% for TGs, and 7% for HDL-C. The survey results indicated high levels of satisfaction. No adverse events were reported.

CONCLUSION

These findings suggest that Barozen Lipid Plus is reliable for measuring lipid profiles and can therefore be used to monitor lipid levels at the time and place of patient care.

What are patients' expectations about the organization of their primary care physicians' practices?

Background

To our knowledge no study has at the same time assessed patients’ satisfaction and their expectations concerning the organizational and contextual aspects of health care provided by their primary care physician (PCP). Assessing these aspects is important to inform future primary healthcare service planning. Our objective was thus to document patients’ satisfaction with and expectations from their PCP, in terms of availability and organization of their practices, and to assess whether these indicators varied across age groups and type of practice (solo, duo, group).

Methods

Cross-sectional study based on the answers to questionnaires completed by patients consulting their PCP in Geneva, Switzerland. A random sample of PCPs was asked to recruit consecutively between 50 and 100 patients coming to the practice for a scheduled medical consultation. The patients were asked to complete an anonymous questionnaire centered on their satisfaction levels and expectations towards their PCP.

Results

One thousand six hundred thirty-seven patients agreed to participate (participation rate: 97 %, women: 63 %, mean age: 54 years). Patient satisfaction was high for all the items, except for the availability of the doctor by phone and for the waiting time in the waiting room. The satisfaction rate increased with age and was higher for small practices. In relation to patients’ expectations from their doctor, older patients and patients visiting larger practices tended to be more demanding.

Conclusions

Patients are generally highly satisfied with their PCP. They have a wide range of expectations which should be taken into account when considering potential improvements.

Primary care clinicians' attitudes towards point-of-care blood testing: a systematic review of qualitative studies

Background

Point-of-care blood tests are becoming increasingly available and could replace current venipuncture and laboratory testing for many commonly used tests. However, at present very few have been implemented in most primary care settings. Understanding the attitudes of primary care clinicians towards these tests may help to identify the barriers and facilitators to their wider adoption. We aimed to systematically review qualitative studies of primary care clinicians’ attitudes to point-of-care blood tests.

Methods

We systematically searched Medline, Embase, ISI Web of Knowledge, PsycINFO and CINAHL for qualitative studies of primary care clinicians’ attitudes towards point-of-care blood tests in high income countries. We conducted a thematic synthesis of included studies.

Results

Our search identified seven studies, including around two hundred participants from Europe and Australia. The synthesis generated three main themes: the impact of point-of-care testing on decision-making, diagnosis and treatment; impact on clinical practice more broadly; and impact on patient-clinician relationships and perceived patient experience. Primary care clinicians believed point-of-care testing improved diagnostic certainty, targeting of treatment, self-management of chronic conditions, and clinician-patient communication and relationships. There were concerns about test accuracy, over-reliance on tests, undermining of clinical skills, cost, and limited usefulness.

Conclusions

We identified several perceived benefits and barriers regarding point-of-care tests in primary care. These imply that if point-of-care tests are to become more widely adopted, primary care clinicians require evidence of their accuracy, rigorous testing of the impact of introduction on patient pathways and clinical practice, and consideration of test funding.

Patient satisfaction with point-of-care testing in general practice

BACKGROUND

Point-of-care testing is increasingly being used in general practice to assist GPs in their management of patients with chronic disease. However, patient satisfaction and acceptability of point-of-care testing in general practice has not been widely studied.

AIM

To determine if patients are more satisfied with point-of-care testing than with pathology laboratory testing for three chronic conditions.

DESIGN OF STUDY

As part of a large multicentre, randomised, controlled trial assessing the use of point-of-care testing in Australian general practice, satisfaction was measured for patients having pathology testing performed by point-of-care testing devices or pathology laboratories. Patients in the trial were managed by GPs for diabetes, hyperlipidaemia, and/or anticoagulant therapy.

METHOD

Patient satisfaction was measured using level of agreement with a variety of statements at the end of the study with a patient satisfaction questionnaire for both the intervention and control groups. Analysis was performed using a mixed model analysis of variance (ANOVA) with allowance for clustering at the practice level following Box-Cox transformations of the data to achieve normality.

RESULTS

Overall, intervention patients reported that they were satisfied with point-of-care testing. In comparison with the control group, the intervention group had a higher level of agreement than control patients with statements relating to their satisfaction with the collection process (P<0.001) and confidence in the process (P<0.001). They also viewed point-of-care testing as strengthening their relationship with their GP (P = 0.010) and motivational in terms of better managing their condition (P<0.001).

CONCLUSION

The results from this trial support patient satisfaction and acceptability of point-of-care testing in a general practice setting.

Design, implementation and results of the quality control program for the Australian government's point of care testing in general practice trial

BACKGROUND

From 2005 to 2007 the Australian Government funded a multicentre, clustered randomized controlled trial to determine the clinical effectiveness, cost-effectiveness, satisfaction and safety of point of care testing (PoCT) in general practice (GP). PoC tests measured (and devices used) in the trial were haemoglobin A1c and urine albumin:creatinine ratio (DCA 2000), lipids (Cholestech LDX) and international normalized ratio (CoaguChek S).

METHODS

An internal quality control (QC) program was developed as part of a quality management framework for the trial. PoCT device operators were provided with a colour-coded QC Result Sheet and QC Action Sheet for on-site recording and interpreting of their results. Within-practice imprecision for QC testing was calculated and compared with the analytical goals for imprecision set prior to the trial.

RESULTS

The average participation rate for QC testing was 91% or greater. Median within-practice imprecision met the analytical goals for all PoC tests, except for high-density lipoprotein-cholesterol (HDL-C) where observed performance was outside the minimum goal for one level and one lot number of QC. Most practices achieved the imprecision goals for all analytes, with the principal exception of HDL-C.

CONCLUSIONS

Results from QC testing indicate that PoCT in the GP trial met the analytical goals set for the trial, with the exception of HDL-C.

A pragmatic cluster randomised controlled trial to evaluate the safety, clinical effectiveness, cost effectiveness and satisfaction with point of care testing in a general practice setting - rationale, design and baseline characteristics

BACKGROUND

Point of care testing (PoCT) may be a useful adjunct in the management of chronic conditions in general practice (GP). The provision of pathology test results at the time of the consultation could lead to enhanced clinical management, better health outcomes, greater convenience and satisfaction for patients and general practitioners (GPs), and savings in costs and time. It could also result in inappropriate testing, increased consultations and poor health outcomes resulting from inaccurate results. Currently there are very few randomised controlled trials (RCTs) in GP that have investigated these aspects of PoCT.

DESIGN/METHODS

The Point of Care Testing in General Practice Trial (PoCT Trial) was an Australian Government funded multi-centre, cluster randomised controlled trial to determine the safety, clinical effectiveness, cost effectiveness and satisfaction of PoCT in a GP setting.The PoCT Trial covered an 18 month period with the intervention consisting of the use of PoCT for seven tests used in the management of patients with diabetes, hyperlipidaemia and patients on anticoagulant therapy. The primary outcome measure was the proportion of patients within target range, a measure of therapeutic control. In addition, the PoCT Trial investigated the safety of PoCT, impact of PoCT on patient compliance to medication, stakeholder satisfaction, cost effectiveness of PoCT versus laboratory testing, and influence of geographic location.

DISCUSSION

The paper provides an overview of the Trial Design, the rationale for the research methodology chosen and how the Trial was implemented in a GP environment. The evaluation protocol and data collection processes took into account the large number of patients, the broad range of practice types distributed over a large geographic area, and the inclusion of pathology test results from multiple pathology laboratories.The evaluation protocol developed reflects the complexity of the Trial setting, the Trial Design and the approach taken within the funding provided. The PoCT Trial is regarded as a pragmatic RCT, evaluating the effectiveness of implementing PoCT in GP and every effort was made to ensure that, in these circumstances, internal and external validity was maintained.

TRIAL REGISTRATION

12612605000272695.