Daniels Rob, Cottin Juliette, Khanafer Nagham
Townsend Health Medical Centre, Seaton EX12 2RY, UK.
CEMKA, 92340 Bourg-la-Reine, France.
Diagnostics (Basel). 2023 May 28;13(11):1888. doi: 10.3390/diagnostics13111888.
In 2020, health systems across the world responded to the COVID-19 pandemic by making rapid changes to reduce the risk of exposure in patients and healthcare professionals. The use of point-of-care tests (POCT) has been a central strategy in dealing with the COVID-19 pandemic. The aims of this study were to evaluate the impact of POCT strategy (1) on maintaining elective surgeries by removing the risk of delayed pre-appointment testing and turn-around times and (2) on time dedicated for end-to-end appointment and management, and (3) to assess the feasibility of using the ID NOW among healthcare professionals and patients in a primary care setting, requiring pre-surgical appointment and minor ENT surgery in the Townsend House Medical Centre (THMC), Devon, United Kingdom.
A logistic regression was performed to identify factors associated with the risk of canceled or delayed surgeries and medical appointments. Second, a multivariate linear regression analysis was conducted to calculate changes in the time dedicated to administrative tasks. A questionnaire was developed to assess the acceptance of POCT in patients and staff.
274 patients were included in this study; 174 (63.5%) in Group 1 (Usual Care) and 100 (36.5%) in Group 2 (Point of Care). Multivariate logistic regression showed that the percentage of postponed or canceled appointments was similar between the two groups (adjusted OR = 0.65, [95%CI: 0.22-1.88]; = 0.42). Similar results were observed for the percentage of postponed or canceled scheduled surgeries (adjusted OR = 0.47, [95%CI: 0.15-1.47]; = 0.19). The time dedicated to administrative tasks was significantly lowered by 24.7 min in G2 compared to G1 ( < 0.001). 79 patients in G2 (79.0%) completed the survey, and the majority agreed or strongly agreed that it improved care management (79.7%), decreased administrative time (65.8%), reduced the risk of canceled appointments (74.7%) and the traveling time to do COVID-19 test (91.1%). Having point-of-care testing in the clinic in the future seemed more than welcome by 96.6% of patients; 93.6% declared to be less stressed by having the test at the clinic than waiting for the results of the test realized elsewhere. The five healthcare professionals of the primary care center completed the survey, and all agreed that the POCT positively influences the workflow and can be successfully implemented into routine primary care.
Our study shows that NAAT-based point-of-care SARS-CoV-2 testing significantly improved flow management in a primary care setting. POC testing was a feasible and well-accepted strategy by patients and providers.
2020年，全球卫生系统为应对新冠疫情迅速做出改变，以降低患者和医护人员的接触风险。即时检验（POCT）的使用一直是应对新冠疫情的核心策略。本研究的目的是评估POCT策略（1）通过消除预约前检测延迟和周转时间的风险对维持择期手术的影响，（2）对用于端到端预约和管理的时间的影响，以及（3）评估在英国德文郡汤森豪斯医疗中心（THMC）进行术前预约和小型耳鼻喉科手术的基层医疗环境中，医护人员和患者使用ID NOW的可行性。
进行逻辑回归以确定与手术取消或延迟以及医疗预约风险相关的因素。其次，进行多元线性回归分析以计算用于行政任务的时间变化。编制了一份问卷以评估患者和工作人员对POCT的接受程度。
本研究纳入了274名患者；第1组（常规护理）174例（63.5%），第2组（即时护理）100例（36.5%）。多元逻辑回归显示，两组之间推迟或取消预约的百分比相似（调整后的OR = 0.65，[95%CI：0.22 - 1.88]；P = 0.42）。对于推迟或取消的预定手术百分比也观察到类似结果（调整后的OR = 0.47，[95%CI：0.15 - 1.47]；P = 0.19）。与第1组相比，第2组用于行政任务的时间显著减少了24.7分钟（P < 0.001）。第2组的79名患者（79.0%）完成了调查，大多数人同意或强烈同意它改善了护理管理（79.7%）、减少了行政时间（65.8%）、降低了取消预约的风险（74.7%）以及进行新冠病毒检测的出行时间（91.1%）。96.6%的患者似乎非常欢迎未来在诊所进行即时检验；93.6%的患者表示在诊所进行检测比在其他地方等待检测结果压力更小。基层医疗中心的五名医护人员完成了调查，所有人都同意POCT对工作流程有积极影响，并且可以成功应用于常规基层医疗。
我们的研究表明，基于核酸扩增技术的即时新冠病毒检测显著改善了基层医疗环境中的流程管理。即时检验是患者和提供者可行且接受度高的策略。
