Using selected POCT methods by general practitioners in the Czech Republic

Czech version

Authors: Jan Bělobrádek ¹; Luděk Šídlo ²; Kateřina Maláková ²
Authors‘ workplace: Ústav preventivního lékařství LF UK v Hradci Králové ¹; Katedra demografie a geodemografie PřF UK v Praze ²
Published in: Čas. Lék. čes. 2021; 160: 185-192
Category: Original Articles

Overview

Point-of-care tests allows for the more effective and rapid diagnosis of acute conditions, better management of chronic disease and the rational use of prescribed medicines. The use of selected non-mandatory tests was analysed in relation to their availability across urban and rural general medical practices in Czechia.

Data for 2016 were obtained from the largest health insurance company in Czechia. To categorise the different types of surgery, a spatial model was created applying the OECD regional typology to primary care in Czechia.

International normalised ratio (INR) was the most commonly available test, with 53.1 %. In acute care, C-reactive protein (CRP) testing was most extensively present, with 50.9 %. In practice, though, 90 % of these surgeries performed these tests. Both INR and CRP accounted for 42.7 %, whereas 61.3 % used at least one. Contracts of haemoglobin A_1c amounted 14.8 %, 38.6 % of practices were not contracted to perform any of three tests, and 43.4 % reported no usage at all.

Around half of all general practitioners in Czechia are contracted to provide the most popular non-mandatory point-of-care tests. Reported usage differed among the various surgery typologies, with more peripheral surgeries reporting higher rates.

Keywords:

Primary care – general practice – rural health – point-of care

Sources

Schols AMR, Dinant GJ, Hopstaken R et al. International definition of a point-of-care test in family practice: a modified e-Delphi procedure. Fam Pract 2018; 35 (4): 475-480.
Florkowski C, Don-Wauchope A, Gimenez N et al. Point-of-care testing (POCT) and evidence-based laboratory medicine (EBLM) - does it leverage any advantage in clinical decision making? Crit Rev Clin Lab Sci 2017; 54 (7–8): 471-494.
Larsson A, Greig-Pylypczuk R, Huisman A. The state of point-of-care testing: a European perspective. Ups J Med Sci 2015; 120 (1): 1-10.
Lewandrowski EL, Yeh S, Baron J et al. Implementation of point-of-care testing in a general internal medicine practice: A confirmation study. Clin Chim Acta 2017; 473: 71-74.
El-Osta A, Woringer M, Pizzo E et al. Does use of point-of-care testing improve cost-effectiveness of the NHS Health Check programme in the primary care setting? A cost-minimisation analysis. BMJ Open 2017; 7 (8): e015494.
Hardy V, Thompson M, Alto W et al. Exploring the barriers and facilitators to use of point of care tests in family medicine clinics in the United States. BMC Fam Pract 2016; 17 (1): 149.
Turner PJ, Van den Bruel A, Jones CH et al. Point-of-care testing in UK primary care: a survey to establish clinical needs. Fam Pract 2016; 33 (4): 388-394.
Howick J, Cals JW, Jones C et al. Current and future use of point-of-care tests in primary care: an international survey in Australia, Belgium, The Netherlands, the UK and the USA. BMJ Open 2014; 4 (8): e005611.
Varzgaliene L, Heerey A, Cox C et al. Point-of-care testing in primary care: needs and attitudes of Irish GPs. BJGP Open 2017; 1 (4): bjgpopen17X101229.
Lingervelder D, Koffijberg H, Kusters R, IJzerman MJ. Point-of-care testing in primary care: A systematic review on implementation aspects addressed in test evaluations. Int J Clin Pract 2019; 73 (10): e13392.
Crocker B, Lewandrowski EL, Lewandrowski N et al. Patient satisfaction with point-of-care laboratory testing: report of a quality improvement program in an ambulatory practice of an academic medical center. Clin Chim Acta 2013; 424: 8-11.
Laurence CO, Gialamas A, Bubner T et al.; Point of Care Testing in General Practice Trial Management Group. Patient satisfaction with point-of-care testing in general practice. Br J Gen Pract 2010; 60 (572): e98-104.
Seifert B., Springer D., Racek J., Zima T. POCT metody. Doporučené diagnostické a terapeutické postupy pro všeobecné praktické lékaře. Společnost všeobecného lékařství ČLS JEP, Praha, 2020. Dostupné na: www.svl.cz/files/files/Doporucene-postupy/2020/DP-POCT.pdf
Tadros R, Shakib S. Warfarin indications, risks and drug interactions. Aust Fam Physician 2010; 39 (7): 476-479.
Kvasnička J., Seifert B. Antitrombotická prevence a léčba v primární péči. Novelizace 2018. Doporučené diagnostické a terapeutické postupy pro všeobecné praktické lékaře. Společnost všeobecného lékařství ČLS JEP, Praha, 2018. Dostupné na: www.svl.cz/files/files/Doporucene-postupy/2017/DP-Antitrombo.pdf
Huang Y, Chen R, Wu T et al. Association between point-of-care CRP testing and antibiotic prescribing in respiratory tract infections: a systematic review and meta-analysis of primary care studies. Br J Gen Pract 2013; 63 (616): e787-794.
Karen I., Kolek V., Matoušková M. et al. Antibiotická terapie respiračních, močových a kožních infekcí v ordinaci všeobecného praktického lékaře. Novelizace 2018. Doporučené diagnostické a terapeutické postupy pro všeobecné praktické lékaře. Společnost všeobecného lékařství ČLS JEP, Praha, 2018. Dostupné na: www.svl.cz/files/files/Doporucene-postupy/2017/DP-Antibioticka-terapie-2018.pdf
Matteucci E, Giampietro O. Point-of-care testing in diabetes care. Mini Rev Med Chem 2011; 11 (2): 178-84.
Šídlo L., Novák M. Péče o diabetiky v ordinacích všeobecných praktických lékařů. Nakladatelství P3K, Praha, 2020.
Karen I., Svačina Š. Diabetes mellitus. Novelizace 2020. Doporučené diagnostické a terapeutické postupy pro všeobecné praktické lékaře. Společnost všeobecného lékařství ČLS JEP, Praha, 2020. Dostupné na: www.svl.cz/files/files/Doporucene-postupy/2020/DIABETES-MELLITUS-2020.pdf
Všeobecná zdravotní pojišťovna ČR. Výroční zpráva VZP ČR za rok 2016. VZP ČR, 2017. Dostupné na: https://media.vzpstatic.cz/media/Default/vyrocni-zpravy/vyrocni-zprava-vzp-2016.pdf
Bělobrádek J, Šídlo L, Javorská K, Halata D. Urban or Rural GP? In the Czech Republic it is not just distances that matter. Acta Medica (Hradec Králové) 2021; 64 (1): 15-21.
OECD. Regional Typology. OECD, Paris, 2011. Dostupné na: www.oecd.org/cfe/regional-policy/OECD_regional_typology_Nov2012.pdf
Haldrup S, Thomsen RW, Bro F et al. Microbiological point of care testing before antibiotic prescribing in primary care: considerable variations between practices. BMC Fam Pract 2017; 18 (1): 9.
Seifert B, Vojtíšková J, Vitásek Z. Trendy v indikaci vybraných laboratorních metod všeobecnými praktickými lékaři. Časopis lékařů českých 2016; 155 (3): 6-10.
Huddy JR, Ni MZ, Barlow J et al. Point-of-care C-reactive protein for the diagnosis of lower respiratory tract infection in NHS primary care: a qualitative study of barriers and facilitators to adoption. BMJ Open 2016 Mar 3;6 (3): e009959.
Azevedo P, Costa J, Vaz-Carneiro A. Análise da revisão Cochrane: biomarcadores em testes rápidos para guiar a prescrição de antibióticos em doentes com infecções respiratórias agudas nos cuidados de saúde primários. Cochrane Database Syst Rev 2014; 11: CD010130.
Köchling A, Löffler C, Reinsch S et al. Reduction of antibiotic prescriptions for acute respiratory tract infections in primary care: a systematic review. Implement Sci 2018; 13 (1): 47.
Martínez-González NA, Keizer E, Plate A et al. Point-of-care C-reactive protein testing to reduce antibiotic prescribing for respiratory tract infections in primary care: systematic review and meta-analysis of randomised controlled trials. Antibiotics (Basel). 2020; 9 (9): 610.
Francis NA, Gillespie D, White P et al. C-reactive protein point-of-care testing for safely reducing antibiotics for acute exacerbations of chronic obstructive pulmonary disease: the PACE RCT. Health Technol Assess 2020; 24 (15): 1-108.
Cals JW, Ament AJ, Hood K et al. C-reactive protein point of care testing and physician communication skills training for lower respiratory tract infections in general practice: economic evaluation of a cluster randomized trial. J Eval Clin Pract 2011; 17 (6): 1059-1069.
Hunter R. Cost-effectiveness of point-of-care C-reactive protein tests for respiratory tract infection in primary care in England. Adv Ther 2015; 32 (1): 69-85.
Løkkegaard T, Pedersen TH, Lind B et al. Good quality of oral anticoagulation treatment in general practice using international normalised ratio point of care testing. Dan Med J 2015; 62 (2): A5010.
Gateman D, Trojnar ME, Agarwal G. Time in therapeutic range: Warfarin anticoagulation for atrial fibrillation in a community-based practice. Can Fam Physician 2017; 63 (10): e425-e431.
Björck F, Sandén P, Renlund H et al. Warfarin treatment quality is consistently high in both anticoagulation clinics and primary care setting in Sweden. Thromb Res 2015; 136 (2): 216-220.
Bernaitis N, Badrick T, Anoopkumar-Dukie S. Dedicated warfarin care programme results in superior warfarin control in Queensland, Australia. Int J Clin Pract 2018; 72 (3): e13051.
Streit S, Kaplan V, Busato A et al.; FIRE Study Group. General Practitioners' vitamin K antagonist monitoring is associated with better blood pressure control in patients with hypertension--a cross-sectional database study. BMC Cardiovasc Disord 2015; 15: 47.
Al-Ansary L, Farmer A, Hirst J et al. Point-of-care testing for HbA_1c in the management of diabetes: a systematic review and metaanalysis. Clin Chem 2011; 57 (4): 568-576.
Spaeth BA, Shephard MD, Schatz S. Point-of-care testing for haemoglobin A_1c in remote Australian Indigenous communities improves timeliness of diabetes care. Rural Remote Health 2014; 14 (4): 2849.
Kristensen T, Rose-Olsen K, Skovsgaard CV. Effects of point-of-care testing in general practice for type 2 diabetes patients on ambulatory visits and hospitalizations. Int J Environ Res Public Health 2020; 17 (17): 6185.
Kristensen T, Waldorff FB, Nexøe J et al. Variation in point-of-care testing of HbA_1c in diabetes care in general practice. Int J Environ Res Public Health 2017; 14(11): 1363.

Labels

Addictology Allergology and clinical immunology Angiology Audiology Clinical biochemistry Dermatology & STDs Paediatric gastroenterology Paediatric surgery Paediatric cardiology Paediatric neurology Paediatric ENT Paediatric psychiatry Paediatric rheumatology Diabetology Pharmacy Vascular surgery Pain management

Antibodies from previous infection bring sufficient and long-term protection against COVID-19

Factors influencing the end-of-life decisionmaking process about care in hospitalized patients

Modern trends in management of complicated gastrointestinal ostomies

The context and historical correlations of the origin and development of the oldest continually existing residential alcohol treatment model ("Apolinar model") in Central Europe from 1948 to 1960

Uvádíte správně použitou literaturu?

Zemřel prof. Oldřich Eliška, doyen českých anatomů

Přednáškové večery Spolku českých lékařů v Praze (říjen - prosinec 2021)

Article was published in