Utilisation of remote capillary blood testing in an outpatient clinic setting to improve shared decision making and patient and clinician experience: a validation and pilot study

Abstract

BackgroundIn a tertiary respiratory centre, large cohorts of patients are managed in an outpatient setting and require blood tests to monitor disease activity and organ toxicity. This requires either visits to tertiary centres for phlebotomy and physician review or utilisation of primary care services.ObjectivesThis study aims to validate remote capillary blood testing in an outpatient setting and analyse impact on clinical pathways.MethodsA single-centre prospective cross-sectional validation and parallel observational study was performed. Remote finger prick capillary blood testing was validated compared with local standard venesection using comparative statistical analysis: paired t-test, correlation and Bland-Altman. Capillary was considered interchangeable with venous samples if all three criteria were met: non-significant paired t-test (ie, p>0.05), Pearson’s correlation coefficient (r)>0.8% and 95% of tests within 10% difference through Bland-Altman (limits of agreement). In parallel, current clinical pathways including phlebotomy practice were analysed over 4 weeks to review test predictability. A subsequent pilot cohort study analysed potential impact of remote capillary blood sampling on shared decision making. A final implementation phase ensued to embed the service into clinical pathways within the institution.Results117 paired capillary and venous blood samples were prospectively analysed. Interchangeability with venous blood was seen with glycated haemoglobin (%), total protein and C reactive protein. Further tests, although not interchangeable, are likely useful to enable longitudinal remote monitoring (eg, liver function and total IgE). 65% of outpatient clinic blood tests were predictable with 16% of patients requiring further follow-up. Patient and clinician-reported improvement in shared decision making given contemporaneous blood test results was observed.ConclusionsRemote capillary blood sampling can be used accurately for specific tests to monitor chronic disease, and when incorporated into an outpatient clinical pathway can improve shared decision making and patient experience. Further research is required to determine health economic impact and applicability within telemedicine-based outpatient care.

Remote self-collection of capillary blood using upper arm devices for autoantibody analysis in patients with immune-mediated inflammatory rheumatic diseases

“…In line with our results, previous studies could demonstrate that UA-based self-sampling is perceived as less painful compared with traditional venous blood collection 28 and finger pricking. 27 Similarly, perceived usability of both devices (SUS: Tasso+: 88.6; TAP II: 86.0) was higher compared with finger pricking (61.0 37 and 80.7 29 ), likely due to automatic blood collection. The NPS (likelihood to promote device) of both devices was as high (+28.6%) as in our previous study, comparing a former Tasso version with finger pricking (Tasso-SST: NPS +28%; finger pricking −20%).…”

“…Remote longitudinal serological monitoring could improve early flare detection, 25 reduce clinical visits, 50 offer time-saving for patients and clinicians, empower patients and improve shared decision-making. 37 It would add valuable objective data to complement currently available remote PROs, such as electronic questionnaires 51 and wearable data. 52 Exact quantification of autoantibody levels is currently not clinically relevant for all IMRDs, however, increasing evidence exists for MPO, 9 PR3 8 9 and especially dsDNA, 7 and our study demonstrates clinical utility with very good agreement for PR3 (r=0.9818 (p<0.0001), mean bias −2.03%).…”

“…Mixed data exist on equivalence of capillary blood, regarding liver 37 and kidney function tests 37 54 and complete blood count. 37 55 56 Promising results have been recently published regarding completely non-invasive measurement of CRP via saliva 57 or even continuously real time via a sweat-based wrist wearable. 58 …”

“…For the biomarkers with at least 10 positive individuals, group statistics were applied following the methodology presented by Nwankwo et al . 37 First, biomarker data were analysed for normal distribution using the Anderson-Darling goodness-of-fit test. Data following a normal distribution (Ro52) were analysed by paired t-test and Pearson correlation, whereas non-normally distributed data (CTD screen, PR3, RF IgM and CRP) were analysed using Wilcoxon rank test and Spearman’s rank correlation.…”

Remote capillary blood collection for HbA1c measurement during the COVID‐19 pandemic: A laboratory and patient perspective

“…Involvement of patients in clinical decision making has been reported to improve health outcomes and adherence to treatment/medication. 20 Nwankwo et al reported that participants ( n = 8) involved in a pilot study for remote capillary sampling agreed that the remote capillary collection process resulted in better decision making and planning of care. 20 Our study findings support those of Nwanko et al, with our participants supporting a greater uptake of this remote collection approach.…”