Point-of-care tests for infectious diseases: Barriers to implementation across three London teaching hospitals

Our paper explores results of the acceptability and implementation issues of point of care tests (POCTs) in paediatric patients in three south London hospitals. Overall, we found that having a test result was thought to improve bed management and cohorting sick patients appropriately, reassure parents about their child’s condition, reduce hospital transmission, and rationalise further tests and treatment. Concerns focused on confidence about the test’s performance – particularly around false negatives not receiving proper management, how to manage discrepant results (i.e. the laboratory assay gave a different answer to the POCT), and training enough staff to run the test at the point of care.

Publication

Bustinduy AL, Jeyaratnam D, Adams EJ, et al. CLAHRC South London; Paediatric Infection Network. Point-of-care tests for infectious diseases: Barriers to implementation across three London teaching hospitals. Acta Paediatrica,  April 2017. DOI: 10.1111/apa.13867

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Increased efficiency and improved treatment for stable HIV patients in England

Problem: There was no guidance in England on how frequently stable HIV patients should attend clinics for routine visits, how frequently they should receive their HIV drugs and whether or not it would be cost efficient for patients to collect their drugs from the hospital pharmacy (which incurs VAT) or receive them through a home delivery (with associated delivery cost).

Approach: We built a simple spreadsheet tool in Microsoft Excel to estimate which strategy was the most cost-efficient. Local data from St George’s hospital were obtained and analysed, and supplemented with nationally published data as inputs in the model. Results suggested that the most cost efficient way of delivering care was to see stable patients for routine visits every six months in clinic, and give them their drugs through home delivery every three months; this would also save the most drug wastage for example if patients needed to switch to a new drug regimen. Results suggested that this could save roughly £2000 per patient annually, and roughly £8 million if it were implemented across England to the 4000 HIV patients in 2012.

Impact: Results were given to the London HIV commissioners, published in a peer-reviewed journal, and the tool is available to healthcare professionals so that they can put in their local data to help them make better decisions about healthcare provision.

 

Testimonial

“It has been a pleasure to work with Dr Elisabeth Adams on our costing project for HIV home delivery of drugs. I have also worked with her on research related to the POPI study of chlamydia screening.

She has a very professional and thorough approach to her work, and is good at delivering to timelines. I can recommend her as a partner for future work.”

  • Dr Phillip Hay, Reader and Honorary Consultant, Sexual Health and HIV Medicine, St. George’s Hospital, London

 

Related publications

publication_iconAdams EJ, Ogden D, Ehrlich A, Hay P. Treatment for stable HIV patients in England: can we save costs and improve patient care? Journal of Health Services Research & Policy. Published online 29 Oct 2013, doi:10.1177/1355819613508176

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