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A mathematical model for designing networks of C-Reactive Protein point of care testing


Autoři: Carlos Lamas-Fernandez aff001;  Gail Hayward aff002;  Michael Moore aff003;  Thomas Monks aff004
Působiště autorů: NIHR CLAHRC Wessex, University of Southampton, Southampton, United Kingdom aff001;  NIHR Community Healthcare MIC, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom aff002;  Primary Care and Population Sciences, University of Southampton, Southampton, United Kingdom aff003;  University of Exeter Medical School, University of Exeter, Exeter, United Kingdom aff004
Vyšlo v časopise: PLoS ONE 14(9)
Kategorie: Research Article
doi: https://doi.org/10.1371/journal.pone.0222676

Souhrn

One approach to improving antibiotic stewardship in primary care may be to support all General Practitioners (GPs) to have access to point of care C-Reactive Protein tests to guide their prescribing decisions in patients presenting with symptoms of lower respiratory tract infection. However, to date there has been no work to understand how clinical commissioning groups might approach the practicalities of system-wide implementation. We aimed to develop an accessible service delivery modelling tool that, based on open data, could generate a layout of the geographical distribution of point of care facilities that minimised the cost and travel distance for patients across a given region. We considered different implementation models where point of care tests were placed at either GP surgeries, pharmacies or both. We analysed the trade-offs between cost and travel found by running the model under different configurations and analysing the model results in four regions of England (two urban, two rural). Our model suggests that even under assumptions of short travel distances for patients (e.g. under 500m), it is possible to achieve a meaningful reduction in the number of necessary point of care testing facilities to serve a region by referring some patients to be tested at nearby GP surgeries or pharmacies. In our test cases pharmacy-led implementation models resulted in some patients having to travel long distances to obtain a test, beyond the desired travel limits. These results indicate that an efficient implementation strategy for point of care tests over a geographic region, potentially building on primary care networks, might lead to significant cost reduction in equipment and associated personnel training, maintenance and quality control costs; as well as achieving fair access to testing facilities.

Klíčová slova:

Medicine and health sciences – Surgical and invasive medical procedures – Pharmacology – Drugs – Biology and life sciences – Population biology – Population dynamics – Geographic distribution – Microbiology – Microbial control – Antimicrobials – Antibiotics – Physical sciences – Mathematics – Optimization – Earth sciences – Geography – Regional geography – Geographical regions – Geographic areas – Rural areas – Urban areas – Research and analysis methods – Research design – Survey research – Census


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2019 Číslo 9
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