Engel Nora, Ganesh Gayatri, Patil Mamata, Yellappa Vijayashree, Vadnais Caroline, Pai Nitika Pant, Pai Madhukar
Department of Health, Ethics & Society, Research School for Public Health and Primary Care, Maastricht University, Postbus 616, Maastricht, MD, NL - 6200, The Netherlands.
Institute of Public Health, #250, 2nd C Main, 2nd C Cross, Girinagar I Phase, Bangalore, 560 085, India.
BMC Health Serv Res. 2015 Dec 14;15:550. doi: 10.1186/s12913-015-1223-3.
The core objective of any point-of-care (POC) testing program is to ensure that testing will result in an actionable management decision (e.g. referral, confirmatory test, treatment), within the same clinical encounter (e.g. POC continuum). This can but does not have to involve rapid tests. Most studies on POC testing focus on one specific test and disease in a particular healthcare setting. This paper describes the actors, technologies and practices involved in diagnosing major diseases in five Indian settings - the home, community, clinics, peripheral laboratories and hospitals. The aim was to understand how tests are used and fit into the health system and with what implications for the POC continuum.
The paper reports on a qualitative study including 78 semi-structured interviews and 13 focus group discussions with doctors, nurses, patients, lab technicians, program officers and informal providers, conducted between January and June 2013 in rural and urban Karnataka, South India. Actors, diseases, tests and diagnostic processes were mapped for each of the five settings and analyzed with regard to whether and how POC continuums are being ensured.
Successful POC testing hardly occurs in any of the five settings. In hospitals and public clinics, most of the rapid tests are used in laboratories where either the single patient encounter advantage is not realized or the rapidity is compromised. Lab-based testing in a context of manpower and equipment shortages leads to delays. In smaller peripheral laboratories and private clinics with shorter turn-around-times, rapid tests are unavailable or too costly. Here providers find alternative measures to ensure the POC continuum. In the home setting, patients who can afford a test are not/do not feel empowered to use those devices.
These results show that there is much diagnostic delay that deters the POC continuum. Existing rapid tests are currently not translated into treatment decisions rapidly or are not available where they could ensure shorter turn-around times, thus undermining their full potential. To ensure the success of POC testing programs, test developers, decision-makers and funders need to account for such ground realities and overcome barriers to POC testing programs.
任何即时检验（POC）项目的核心目标都是确保检验能在同一临床接触过程（如POC连续过程）中产生可采取行动的管理决策（如转诊、确证检验、治疗）。这可能涉及快速检验，但并非必须如此。大多数关于即时检验的研究聚焦于特定医疗环境下的一种特定检验和疾病。本文描述了印度五个场所（家庭、社区、诊所、基层实验室和医院）中诊断主要疾病所涉及的行为主体、技术和实践。目的是了解检验如何被使用以及如何融入卫生系统，以及对POC连续过程有何影响。
本文报告了一项定性研究，于2013年1月至6月在印度南部卡纳塔克邦的农村和城市地区，对医生、护士、患者、实验室技术人员、项目官员和非正规医疗服务提供者进行了78次半结构化访谈和13次焦点小组讨论。针对五个场所中的每一个，绘制了行为主体、疾病、检验和诊断过程，并分析了是否以及如何确保POC连续过程。
在这五个场所中，几乎都未成功开展即时检验。在医院和公立诊所，大多数快速检验在实验室中使用，在这些地方，要么未实现单次患者接触的优势，要么快速性受到影响。在人力和设备短缺的情况下基于实验室的检验会导致延误。在周转时间较短的较小基层实验室和私人诊所，快速检验无法获得或成本过高。在这里，医疗服务提供者会寻找替代措施来确保POC连续过程。在家庭环境中，能够负担得起检验的患者不会/感觉没有能力使用这些设备。
这些结果表明，存在许多诊断延迟阻碍了POC连续过程。现有的快速检验目前未能迅速转化为治疗决策，或者在能够确保更短周转时间的地方无法获得，从而削弱了其全部潜力。为确保即时检验项目的成功，检验开发者、决策者和资助者需要考虑这些实际情况，并克服即时检验项目的障碍。
