Home or Hospital? Point-of-Care CRP as a Triage Biomarker in the Primary Care Setting

ObjectiveTo determine if use of point of care testing (POCT) is less costly than laboratory testing to the National Health Service (NHS) in delivering the NHS Health Check (NHSHC) programme in the primary care setting.DesignObservational study and theoretical mathematical model with microcosting approach.SettingWe collected data on NHSHC delivered at nine general practices (seven using POCT; two not using POCT).ParticipantsWe recruited nine general practices offering NHSHC and a pathology services laboratory in the same area.MethodsWe conducted mathematical modelling with permutations in the following fields: provider type (healthcare assistant or nurse), type of test performed (total cholesterol with either lab fasting glucose or HbA1c), cost of consumables and variable uptake rates, including rate of non-response to invite letter and rate of missed [did not attend (DNA)] appointments. We calculated total expected cost (TEC) per 100 invites, number of NHSHC conducted per 100 invites and costs for completed NHSHC for laboratory and POCT-based pathways. A univariate and probabilistic sensitivity analysis was conducted to account for uncertainty in the input parameters.Main outcome measuresWe collected data on cost, volume and type of pathology services performed at seven general practices using POCT and a pathology services laboratory. We collected data on response to the NHSHC invitation letter and DNA rates from two general practices.ResultsTEC of using POCT to deliver a routine NHSHC is lower than the laboratory-led pathway with savings of £29 per 100 invited patients up the point of cardiovascular disease risk score presentation. Use of POCT can deliver NHSHC in one sitting, whereas the laboratory pathway offers patients several opportunities to DNA appointment.ConclusionsTEC of using POCT to deliver an NHSHC in the primary care setting is lower than the laboratory-led pathway. Using POCT minimises DNA rates associated with laboratory testing and enables completion of NHSHC in one sitting.

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Adoptability and Accuracy of Point-of-Care Ultrasound in Screening for Valvular Heart Disease in the Primary Care setting

10.22541/au.161278735.53735340/v1 ◽

2021 ◽

Author(s):

Yashasvi Chugh ◽

Opema Lohese ◽

Paul Sorajja ◽

Ross Garberich ◽

Lariss Stanberry ◽

...

Keyword(s):

Primary Care ◽

Heart Disease ◽

Valvular Heart Disease ◽

Care Setting ◽

Primary Care Setting ◽

Point Of Care ◽

Primary Care Providers ◽

Left Ventricular ◽

Point Of Care Ultrasound ◽

Care Providers

Background: Despite continued efforts, the majority of patients with valvular heart disease (VHD) remain undiagnosed and untreated. This study aimed to assess the adoptability and accuracy of point-of-care handheld echocardiographic assessments (POCE) in the primary care setting. Methods: Eleven previously untrained primary care providers were trained to use the Vscan Extend (GE, WI) POCE to assess VHD, left ventricular function (LVEF), and major extra-cardiac findings. Their assessments were compared to those of 3 blinded expert readers. A total of 180 assessments were evaluated using Kappa statistics (κ) together with their estimated standard error, p-value, and 95% CI bounds. Results: Identical or nearly identical agreement between previously untrained primary providers and expert readers was evident for the diagnosis of tricuspid regurgitation, mitral regurgitation, pericardial effusion, volume status. These agreements were strongest in apical long axis (κ =1, p<0.001) and parasternal long and short axis views (k>=0.82 p<0.001), though agreement remained robust in apical 4-chamber views (k>=0.76). The agreements in LVEF assessment were identical in the apical long axis view (κ =1, p<0.001) and robust in the remaining 3 views (κ>=0.66, p<0.001). The assessments of aortic stenosis (parasternal/long, κ =0.42, and parasternal/short, κ =0.47, both p<0.001) were weak in their agreement. Conclusion: Compared to expert echocardiography readers, the untrained providers’ use of POCE for VHD shows high user adoptability and diagnostic accuracies in the primary care setting.

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