Background
Method
Details of the POC test service improvement project
Recruitment
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Their views on having POCT available to them during home visits to patients
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Their decision-making about whether (or not) to use the test equipment
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What they perceived as facilitators and barriers to using POCT during home visits
Data collection
Data analysis
Results
Clinician group | Number of interviews |
---|---|
GPs working in OOH service | 4 (interviewed once) 3 (interviewed twice) |
Emergency Practitioners: Advanced Nurse Practitioners (ANPs) (n = 3) and Paramedics (extended care practitioners (ECPs) (n = 3) | 6 |
Ambulatory care physicians | 2 |
Health Care Assistant (HCA) | 1 |
Theme | Sub-themes |
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1. Deciding whether to use POCT | -Is the patient or clinical situation “suitable” -Is the time/effort to do POC tests justified (what is the impact on resources?) -Will POC tests results reduce (or increase) my uncertainty and risk? |
2. When undertaken, how can POC tests be used to make decisions about patient care? | - Determining the type (nature, location, timing) of onward care -Supporting professional communication |
3. Gaining experience in using POCT | - becoming familiar with the equipment - gaining experience and confidence |
Theme 1. Deciding whether to use point of care tests
Is the patient or clinical situation “suitable”?
“you know you're only doing it in cases where it's going to make a difference. So, for that reason, because I'm only doing it where it's going to either swing that decision one way or another, it actually really helps me. I'm not going to be using it where it's not going to make any difference” GP1, interview 2
you know I always shy away from using nitrofurantoin because I don’t know people's renal [function] Whereas if you … .. knew the U&Es were OK, then it might be something you'd then use” GP1, interview 1
What is the impact on resources?
“fiddliness and time – five to fifteen minutes roughly You know, … I don’t like to do it in the patient bed; I need a space “GP4“it's potentially half an hour or something, and also … quite often … .with bad lights and cluttered surfaces” GP7
“other GPs may say, "Oh call out of hours service. They ask them to come out to see you and they may do a blood test." So, when the people they know about it say, "Oh the GP who comes out can do blood tests," so they expect these things from them” GP2, interview 1
Will POC tests results reduce or increase clinicians’ uncertainty and risk?
“you can only take so much from sort of visual and your assessment skills. Actually, it's quite good to just get a broad overview of what their electrolytes are doing you know … . it's quite good to just have those readings just to add sort of justification behind your decision making out in the community” EP6
It's being comfortable with when you get your blood test results; what to do with them, isn't it, is the other thing. GP6
[A] s GPs we carry a lot of risk, and that I think is the bit of our job that GPs do that other specialists can't do, which is in dealing with that uncertainty. And you know the blood tests, I don’t know would necessarily help in that, and that’s the feeling I get from listening to the other clinicians. GP 5, interview 1
“you know the other thing is the sort of CRP, you know that for acute infections and things. So, if someone's got a chest infection you want to think, 'OK, are they really poorly?' You know, you're trying to make that decision whether you can leave them at home.” GP 6
everyone who's got some sort of illness will have a raised CRP. And the question is … you know if it was up at ten or twenty, that’s significant, whilst if you knew the trajectory was, you know fifty yesterday and it's ten today – great. But if it's ten now but in a few hours' time it's going to be fifty or a hundred, you can't know that” GP5, interview 2
Theme 2: when undertaken, how can POC tests be used to make decisions about patient care?
Determining onward care
“there's certainly been one case that I can remember that, we had the blood results and … , they said, “ they're slightly abnormal but we think, you know it can wait," and I think then rather than send them in overnight … I think they arranged to go into AAU (acute ambulatory unit) the next day” EP4
“it gives you more sort of clarity as to, you know how unwell the patient is.. … ' You might think, 'Oh, they're fine,' and then you might do the bloods and actually, you know they’ve got a really high creatinine, and you think, 'Well actually, they're not fine,' and you know they do need to go in”. EP4
Supporting professional communication
“It's critical because it allows you to kind of focus and we can say, "Look, we've done this, this, this and that’s alright, but there's still this one outstanding question." AAU1
“I think that any information that you can give them that will help them to prioritise or to tell you what they want; where they want the patient to go to … ..that’s got to help them with their bed management, but also for the patient's safety” EP5
“it is really difficult for our doctors when you're speaking to them over the phone about a patient and, you know you're relaying information and they haven't got that patient in front of them; they can only go on what you're saying, whereas if you give them some actual, hard evidence .. … that is what the blood result is”. EP6
Facilitating shared decision making
“we were able to support what he wanted; that he didn’t need to go in acutely; we just needed to keep an eye on him and then we got him to agree that, 'Look, OK we agree with you, your bloods are OK-ish and your observations aren’t great but we'll agree that we'll come in and keep an eye on you over the next couple of days if you agree if things get worse you will go in. … and then ultimately it saved an admission” EP2
Theme 3: gaining experience of POC tests
Becoming familiar with the equipment
“once you’ve got the hang of it, I mean it doesn’t actually take that long, so you know really short, I mean ten minutes probably from start to finish” EP4
Learning from clinical cases
“Definitely, a little case history of something, it would be useful wouldn’t it to know what situations they’ve used it in, and has it been useful, you know”.GP6
“My fear was that it would be used like a blunderbuss and start getting people saying, "Oh this lady, have done her bloods and this has come up." And I'd be saying, "Well, why have you done them in the first place?" But that hasn’t been happening. So, yeah I think if it's used where it's going to make a difference, I think it can be very powerful … .I find it very useful and I think if it did go now there are cases where I'd be cursing that it wasn’t available. GP1, interview 2