scholarly journals Assessing the clinical impact and resource use of a 30-minute chlamydia and gonorrhoea point-of-care test at three sexual health services

2021 ◽  
Vol 8 ◽  
pp. 204993612110616
Author(s):  
Susie Huntington ◽  
Georgie Weston ◽  
Elisabeth Adams
Keyword(s):  
Health Services ◽  
Sexual Health ◽  
Resource Use ◽  
Standard Care ◽  
Point Of Care ◽  
Structured Interviews ◽  
Process Data ◽  
Point Of Care Test ◽  
Clinical Benefits ◽  
Patient Groups

Objectives: To assess clinical metrics and resource use of a 30-minute point-of-care test (POCT) for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) compared to laboratory-based testing. Methods: Three English sexual health services (SHSs) were recruited as part of a study. Existing processes for CT/NG testing and treatment were assessed, and adaptions to incorporate the CT/NG POCT were developed during semi-structured interviews. Staff time and consumables data were collected by clinic staff prior to and following introduction of the POCT. Results: SHSs selected patient groups for whom the CT/NG POCT would be used. Testing and treatment process data were collected for 225 patients (n = 118 POC; n = 107 standard). The percentage of patients receiving unnecessary CT treatment was 5% (5/95) and 13% (12/93) for POC and standard care respectively. The average CT/NG pathway cost varied and was on average £61.55 for POC and £50.88 for standard care. For the two SHSs where the POCT was used during a patient’s visit, for standard and POC respectively, the average time to CT treatment was 10.0 and 0.0 days and to NG treatment, 0.3 and 0.0 days. Conclusion: Use of a 30-minute POCT at three SHSs yielded clinical benefits by reducing time to treatment and unnecessary CT treatment.

Economic analysis of the randomised assessment of treatment using panel assay of cardiac markers trial

2010 ◽  
Vol 27 (Suppl 1) ◽  
pp. A5.2-A5
Author(s):  
Steve Goodacre
Keyword(s):  
Economic Analysis ◽  
Resource Use ◽  
Standard Care ◽  
Point Of Care ◽  
Acute Chest Pain ◽  
Cost Effective ◽  
Health Utility ◽  
Cardiac Markers ◽  
Life Years ◽  
Care Costs

BackgroundThe randomised Assessment of Treatment using Panel Assay of Cardiac markers (RATPAC) trial showed that diagnostic assessment with a point-of-care biomarker panel increased successful discharges among patients presenting to hospital with acute chest pain. We aimed to determine whether point-of-care panel assessment reduced healthcare costs and whether it was likely to be cost-effective.MethodsEconomic analysis was undertaken using individual patient resource use data from the RATPAC trial (n=2263) and health utility measured on the EQ-5D at one and 3 months. Resource use was valued using national unit costs. Quality-adjusted life years (QALYs) were calculated from EQ-5D scores using the trapezium rule. Mean costs and QALYs accrued after point-of-care and standard care were compared and cost-effectiveness estimated in terms of probability of dominance and incremental cost per QALY.ResultsPoint-of-care panel assessment was associated with higher emergency department costs, coronary care costs and cardiac intervention costs, but lower general inpatient costs. Mean costs per patient were £1217 with point-of-care versus £1006 with standard care (p=0.047), while mean QALYs were 0.158 versus 0.161 (p=0.250). The probability of standard care being dominant (ie, cheaper and more effective) was 0.888, while the probability of the point-of-care panel being dominant was 0.004. These probabilities were not markedly altered by sensitivity analysis varying the costs of the point-of-care panel and excluding intensive care costs.ConclusionPoint-of-care panel assessment does not reduce costs despite reducing admissions and may even increase costs. It is unlikely to be considered a cost-effective use of national healthcare resources.

scholarly journals Sexual health services in community pharmacy for women on opioid substitution treatment: a qualitative study

2020 ◽  
Vol 30 (4) ◽  
pp. 733-738
Author(s):  
Laura Medina-Perucha ◽  
Jenny Scott ◽  
Sarah Chapman ◽  
Julie Barnett ◽  
Charlotte Dack ◽  
...  
Keyword(s):  
Health Services ◽  
Sexual Health ◽  
Structural Changes ◽  
Sexual Transmission ◽  
Community Pharmacies ◽  
Substitution Treatment ◽  
Structured Interviews ◽  
Framework Analysis ◽  
Opioid Substitution Treatment ◽  
Opioid Substitution

Abstract Background Women on opioid substitution treatment (WOST) are at heightened risk for the sexual transmission of sexually transmitted infections and blood-borne viruses. This study aimed to explore the opportunities to promote their sexual health in community pharmacies in UK. Methods Semi-structured interviews were conducted with 20 WOST and 14 community pharmacists (CPs). A focus group was run with three CPs. Participants were recruited in drug services and a service for sex workers (WOST), and in CP. Data collection took place between October 2016 and September 2017. Data were analyzed using Framework Analysis and directed Content Analysis. Results CPs could play a role in promoting sexual health among WOST. Sexual health screening, treatment and condom supply were suggested as potential ways of delivering pharmacy-based sexual health services. These services should be actively offered to WOST, delivered in a private space and free of cost. We identified several challenges to overcome in order to design and implement sexual health services for WOST in community pharmacies. Conclusions This study highlights the potentially key role CPs can have promoting sexual health and addressing health inequities among WOST. Improvements in pharmacists’ training are required in order to address stigma towards WOST, and promote trust and positive rapport. Structural changes are also needed to broaden the services available for this group of women and improve their access to healthcare.

scholarly journals Sustained Quality and Service Delivery in an Expanding Point-of-Care Testing Network in Remote Australian Primary Health Care

2020 ◽  
Vol 144 (11) ◽  
pp. 1381-1391
Author(s):  
Susan Janet Matthews ◽  
Brooke Spaeth ◽  
Lauren Duckworth ◽  
Janet Noreen Richards ◽  
Emma Prisk ◽  
...  
Keyword(s):  
Health Services ◽  
Clinical Utility ◽  
Point Of Care ◽  
Northern Territory ◽  
Point Of Care Testing ◽  
Analytical Quality ◽  
Testing Program ◽  
Point Of Care Test ◽  
Primary Health ◽  
Remote Health

Context.— Since 2008, the Northern Territory Point-of-Care Testing Program has improved patient access to pathology testing for acute and chronic disease management for remote health services. Objective.— To evaluate the analytical quality, service delivery, and clinical utility of an expanding remote point-of-care testing network. Design.— Four years (2016–2019) of data on analytical quality, test numbers, and training statistics and 6 months of clinical point-of-care testing data from Abbott i-STATs at remote health services throughout the Northern Territory were analyzed to assess analytical performance, program growth, and clinical utility. Results.— From 2016 to 2019, point-of-care test numbers increased, with chemistry and blood gas testing more than doubling to 8500 and 6000 tests, respectively, troponin I testing almost doubling (to 6000), and international normalized ratio testing plateauing at 8000 tests. Participation in quality control and proficiency testing was high, with quality comparable to laboratory-based analytical goals. A shift toward flexible training and communication modes was noted. An audit of point-of-care test results demonstrated elevated creatinine, associated with chronic kidney disease management, as the most common clinically actionable patient result. Conclusions.— The Northern Territory Point-of-Care Testing Program provides high quality point-of-care testing within remote primary health services for acute and chronic patient management and care. Clinical need, sound analytical performance, flexibility in training provision, and effective support services have facilitated the sustainability of this expanding point-of-care testing model in the remote Northern Territory during the past 11 years.

scholarly journals Antimicrobial resistance point-of-care testing for gonorrhoea treatment regimens: cost-effectiveness and impact on ceftriaxone use of five hypothetical strategies compared with standard care in England sexual health clinics

2020 ◽  
Vol 25 (43) ◽  
Author(s):  
Emma M Harding-Esch ◽  
Susie E Huntington ◽  
Michael J Harvey ◽  
Georgie Weston ◽  
Claire E Broad ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Antimicrobial Resistance ◽  
Sexual Health ◽  
Standard Care ◽  
Point Of Care ◽  
Treatment Strategies ◽  
Optimal Treatment ◽  
Health Clinic ◽  
Tree Model ◽  
Treatment Regimens

Background Widespread ceftriaxone antimicrobial resistance (AMR) threatens Neisseria gonorrhoeae (NG) treatment, with few alternatives available. AMR point-of-care tests (AMR POCT) may enable alternative treatments, including abandoned regimens, sparing ceftriaxone use. We assessed cost-effectiveness of five hypothetical AMR POCT strategies: A-C included a second antibiotic alongside ceftriaxone; and D and E consisted of a single antibiotic alternative, compared with standard care (SC: ceftriaxone and azithromycin). Aim Assess costs and effectiveness of AMR POCT strategies that optimise NG treatment and reduce ceftriaxone use. Methods The five AMR POCT treatment strategies were compared using a decision tree model simulating 38,870 NG-diagnosed England sexual health clinic (SHC) attendees; A micro-costing approach, representing cost to the SHC (for 2015/16), was employed. Primary outcomes were: total costs; percentage of patients given optimal treatment (regimens curing NG, without AMR); percentage of patients given non-ceftriaxone optimal treatment; cost-effectiveness (cost per optimal treatment gained). Results All strategies cost more than SC. Strategy B (azithromycin and ciprofloxacin (azithromycin preferred); dual therapy) avoided most suboptimal treatments (n = 48) but cost most to implement (GBP 4,093,844 (EUR 5,474,656)). Strategy D (azithromycin AMR POCT; monotherapy) was most cost-effective for both cost per optimal treatments gained (GBP 414.67 (EUR 554.53)) and per ceftriaxone-sparing treatment (GBP 11.29 (EUR 15.09)) but with treatment failures (n = 34) and suboptimal treatments (n = 706). Conclusions AMR POCT may enable improved antibiotic stewardship, but require net health system investment. A small reduction in test cost would enable monotherapy AMR POCT strategies to be cost-saving.

scholarly journals Challenges in managing urinary tract infection and the potential of a point-of-care test guided care in primary care: an international qualitative study

BJGP Open ◽  
2019 ◽  
Vol 3 (2) ◽  
pp. bjgpopen18X101630 ◽  
Author(s):  
Lucy Brookes-Howell ◽  
Emma Thomas-Jones ◽  
Janine Bates ◽  
Marie-Jet Bekkers ◽  
Curt Brugman ◽  
...  
Keyword(s):  
Primary Care ◽  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Care Delivery ◽  
Point Of Care ◽  
Successful Implementation ◽  
Structured Interviews ◽  
Point Of Care Test ◽  
Primary Care Clinicians

BackgroundLittle is known about clinicians’ experiences of using a point-of-care test (POCT) to inform management of urinary tract infection (UTI) in general practice.AimTo explore experiences of using the Flexicult test to inform management of UTI and views on requirements for an optimal POCT to inform successful implementation.Design & settingTelephone interviews with 35 primary care clinicians and healthcare professionals in Wales, England, Spain, and the Netherlands, who had participated in a trial of the Flexicult POCT for UTI based on urine culture.MethodThematic analysis of semi-structured interviews.ResultsMost primary care clinicians interviewed agreed on the need for a POCT in UTI management, and that the Flexicult POCT delivered quicker results than laboratory results used in usual care, reassured patients, boosted their confidence in decision-making, and reminded them about antibiotic stewardship. However, clinicians also reported difficulties in interpreting results, limitations on when the Flexicult could be used, and concerns that testing all patients would strain care delivery and prolong patient discomfort when delaying decisions until a non-rapid POCT result was available. An optimal POCT would produce more rapid results, and be reliable and easy to use. Uptake into routine care would be enhanced by: clear guidance on which patients should be tested; training for interpreting ‘grey area’ results; reiterating that even ‘straightforward’ cases might be better managed with a test; clear messages about stopping unnecessary antibiotics versus completing a course; and better self-management strategies to accompany implementation of delayed, or non-prescription of, antibiotics.ConclusionPrimary care clinicians believe that POCT tests could play a useful role in the management of UTI and gave clear recommendations for successful implementation.

scholarly journals Staff and Users’ Experiences of Pharmacy-Based Sexual and Reproductive Health Services: A Qualitative Interview Study from the UK

Pharmacy ◽  
2020 ◽  
Vol 8 (4) ◽  
pp. 206
Author(s):  
Julia Gauly ◽  
Jonathan Ross ◽  
Joanne Parsons ◽  
Helen Atherton
Keyword(s):  
Reproductive Health ◽  
Health Services ◽  
Sexual Health ◽  
Sexual And Reproductive Health ◽  
Reproductive Health Services ◽  
Structured Interviews ◽  
Pharmacy Staff ◽  
Qualitative Interview Study ◽  
Consultation Skills ◽  
The Uk

Since August 2015, a large range of sexual health and reproductive health services have been provided in more than 120 pharmacies across Birmingham (England). Our study aimed to explore how pharmacy staff and pharmacy users experience delivering or being provided with sexual health and reproductive health services. Between March and September 2019, semi-structured interviews were conducted with 15 pharmacy staff delivering sexual and reproductive health services and 15 people who had used a sexual and reproductive health service at the pharmacy. Interviews were analysed thematically. Pharmacy users found services convenient to use and were largely satisfied with pharmacy staff consultation skills. Staff were motivated to deliver the services, although some felt that they did not receive sufficient recognition for their work. Barriers to pharmacy-based sexual and reproductive health services were identified, including lack of privacy for users, lack of staff and user awareness of the services, lack of trained staff to deliver services and lack of capacity for copper coil insertions in females presenting for emergency contraception. The identification of barriers to effective service provision can be used to improve the delivery of sexual and reproductive health services in pharmacies and lead to a greater uptake.

scholarly journals The perspectives of asylum seekers when accessing sexual health services in Cork and Kerry

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
M M Jones ◽  
F Barry ◽  
M P Davoren
Keyword(s):  
Health Services ◽  
Sexual Health ◽  
Asylum Seekers ◽  
Help Seeking ◽  
Well Being ◽  
Sexual Relationships ◽  
Barriers And Facilitators ◽  
World Health ◽  
Vulnerable Groups ◽  
Structured Interviews

Abstract Background The World Health Organisation (WHO) states that; “Sexual health is a state of physical, mental and social well-being in relation to sexuality. It requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence.” Asylum seekers are among many vulnerable groups that may face inequalities in terms of sexual health and how sexual health services are accessed. The aim of the present study is to gain an understanding of the experiences of asylum seekers when accessing sexual health services in Cork and Kerry, including the perceived barriers to and factors that facilitate access. Methods This is a qualitative study in which data was collected from 14 semi-structured interviews conducted with asylum seekers between May and June 2019. Participants were over the age of 18 and living in direct provision in Cork or Kerry. The present study uses a content analysis to explore the perspectives of asylum seekers when accessing sexual health services in Cork and Kerry. Results Participants demonstrated varying levels of understanding around the topic of sexual health and sexual health services. Several barriers and facilitators were identified which can be grouped into socioeconomic, political/legal, systemic, and social/cultural/religious barriers and facilitators. Conclusions The findings from this study highlighted several areas for improvement in the provision of information and services in relation to sexual health for asylum seekers living in direct provision and revealed the importance of addressing these issues in order to fulfil the purpose of public health by promoting health, preventing disease and prolonging life for all aspects of society. Key messages This study has identified the barriers and facilitators to accessing sexual health services in the context of the direct provision system in the Republic of Ireland. The results of the study reveal the varying ideas and understanding of the topic of sexual health and how this can influence help-seeking behaviour.

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