Dózsa Csaba, Horváth Krisztián, Cserni István, Cseh Borbála
Faculty of Healthcare, University of Miskolc, Miskolc, Hungary.
Department of Public Health, Semmelweis University Faculty of Medicine, Budapest, Hungary.
Prim Health Care Res Dev. 2022 Apr 21;23:e26. doi: 10.1017/S1463423622000159.
The aim of this study is to give a broad overview of the international best practices regarding the implementation of point-of-care testing (POCT) in primary care (PC) setting and to highlight the facilitators and barriers for widespread national uptake. The study focuses on the managerial and organizational side of POCT, offering a roadmap for implementation as well as highlighting the most important requirements needed to unlock the clinical and economical potential of POCT in the Hungarian healthcare system.
We conducted an English language scoping literature review between January 2012 and June 2021 to assess the recent trends of POCT implementation in developed countries. Our research focuses on the recent publications of several European and Anglo-Saxon countries where POCT utilization is common. In parallel, we reviewed the Hungarian regulatory framework, ongoing governmental legislation, and strategies influencing the POCT dissemination in the Hungarian PC sector.
Among the possible POCT usage in PC, we identified several clinically relevant devices and tests (C-reactive protein, urine, blood glucose, D-dimer, prothrombin time) important in screening and early detection of morbidities representing high disease burden. Based on international literature, general practitioners (GPs) are interested in the shortened diagnostic times, portable devices, and better doctor-patient relations made possible by POCT. There are several concerns, however, regarding initial and operational costs and reimbursement, limited scientific evidence about quality and safety, unclear regulations on quality validation of tests, as well as managerial aspects like PC staff training and IT integration at the GP level.
As our review highlights, there is considerable interest among GPs to implement POCT as it has the potential to improve quality of care; however, there are many obstacles to overcome before widespread uptake. Further investigation is recommended to elaborate management and quality insurance background and to develop appropriate regulatory framework and financial scheme for GP practices. Preferably this work should involve the local practicing GPs to better tailor the implementation roadmap to country-specific details.
本研究旨在全面概述基层医疗环境中即时检验（POCT）实施的国际最佳实践，并突出全国广泛采用的促进因素和障碍。该研究聚焦于POCT的管理和组织层面，提供实施路线图，并强调释放匈牙利医疗体系中POCT临床和经济潜力所需的最重要要求。
我们在2012年1月至2021年6月期间进行了一项英文范围文献综述，以评估发达国家POCT实施的近期趋势。我们的研究聚焦于几个POCT使用普遍的欧洲和盎格鲁-撒克逊国家的近期出版物。同时，我们审查了匈牙利的监管框架、现行政府立法以及影响匈牙利基层医疗领域POCT传播的策略。
在基层医疗中可能使用的POCT里，我们确定了几种对筛查和早期发现代表高疾病负担的病症很重要的临床相关设备和检测（C反应蛋白、尿液、血糖、D-二聚体、凝血酶原时间）。基于国际文献，全科医生（GP）对POCT带来的缩短诊断时间、便携式设备以及更好的医患关系感兴趣。然而，对于初始成本和运营成本及报销、关于质量和安全的科学证据有限、检测质量验证的法规不明确以及基层医疗人员培训和全科医生层面的信息技术整合等管理方面存在诸多担忧。
正如我们的综述所强调的，全科医生对实施POCT有相当大的兴趣，因为它有可能提高医疗质量；然而，在广泛采用之前有许多障碍需要克服。建议进一步调查以阐述管理和质量保障背景，并为全科医生实践制定适当的监管框架和财务方案。这项工作最好应让当地执业全科医生参与，以便更好地根据国家具体细节调整实施路线图。
