Exploring the barriers and facilitators to use of point of care tests in family medicine clinics in the United States

Abstract

BackgroundPoint-of-care tests (POCTs) are increasingly used in family medicine clinics in the United States. While the diagnostics industry predicts significant growth in the number and scope of POCTs deployed, little is known about clinic-level attitudes towards implementation of these tests. We aimed to explore attitudes of primary care providers, laboratory and clinic administrative/support staff to identify barriers and facilitators to use of POCTs in family medicine.MethodsSeven focus groups and four semi-structured interviews were conducted with a total of 52 clinic staff from three family medicine clinics in two US states. Qualitative data from this exploratory study was analyzed using the constant comparison method.ResultsFive themes were identified which included the impact of POCTs on clinical decision-making; perceived inaccuracy of POCTs; impact of POCTs on staff and workflow; perceived patient experience and patient-provider relationship, and issues related to cost, regulation and quality control. Overall, there were mixed attitudes towards use of POCTs. Participants believed the added data provided by POCT may facilitate prompt clinical management, diagnostic certainty and patient-provider communication.Perceived barriers included inaccuracy of POCT, shortage of clinic staff to support more testing, and uncertainty about their cost-effectiveness.ConclusionsThe potential benefits of using POCTs in family medicine clinics are countered by several barriers. Clinical utility of many POCTs will depend on the extent to which these barriers are addressed. Engagement between clinical researchers, industry, health insurers and the primary care community is important to ensure that POCTs align with clinic and patient needs.Electronic supplementary materialThe online version of this article (doi:10.1186/s12875-016-0549-1) contains supplementary material, which is available to authorized users.

Accuracy, user-friendliness and usefulness of the Cobas h232 point-of-care test for NT-proBNP in primary care

“…A critical consideration is the immediacy of the result in cases of slow-onset heart failure. For chronic illnesses, Hardy et al mentioned that knowing the result might not be advantageous when the patient is sitting across from you 21. However, HbA1c POC testing has been described as improving the patient–doctor relationship as well as the level of patient satisfaction and leads to an increased sense of provider responsibility 22 23…”

“…The same issue regarding outsourcing was described for C-reactive protein (CRP) POC testing 27. However, whether the GP or assistant should perform the test remains a point of discussion 21. Moreover, according to the American Association of Clinical Chemistry (AACC), the main issue of POC testing is non-laboratory personnel performing the test, as this applies to both GP and assistant.…”

How can point-of-care HbA1c testing be integrated into UK primary care consultations? – A feasibility study

“…POC testing allows a real-time discussion of the test result between clinicians and patients and removes the need to telephone through results or to schedule follow-on appointments [11]. This streamlined consultation process is more convenient to patients [12] and has been linked to improvements in patient satisfaction and motivation to self-manage [13,14].…”

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“…Several studies on the potential bene ts of using POCTs in acute respiratory infections in primary care medicine have recently been published. This research points to several barriers to the clinical use of many POCTs and the importance of appropriate training for clinicians and support tools for use in practice [23][24][25].…”