Point of Care Testing Trial Report - Executive Summary
2. Is the effectiveness the same or better than for the same tests using pathology laboratory testing?
Table of contents
- I. Overview
- II. Trial Preparation
III. Key Findings and Conclusions for Key Research Questions- 1. Is it safe to perform PoCT in general pratice?
- 2. Is the effectiveness the same or better than for the same tests using pathology laboratory testing?
- 3. Is it the same or more cost-effective to perform PoCT compared with pathology laboratory testing?
- 4. Are patients and other stakeholders more satisfied with PoCT than with pathology laboratory testing?
- 5. Are there differences between urban, rural and remote geographic regions in any of the parameters measured?
- 6. Would the regulatory environment used for the Trial meet the needs of all the stakeholders if PoCT were to be made more generally available?
- 7. What would be the appropriate Medical Benefits Schedule (MBS) fee for the tests selected in the Trial?
- IV. Evaluation of the POCT Trial Implementation
- V. Overall Conclusions and Summary
To answer this research question the Trial looked at four areas around the influence of PoCT on clinical effectiveness. These were therapeutic control, impact on patient care, number of visits to the GP and patient compliance with disease management.
Non-inferior analyses (the same or better) were used to measure therapeutic control and patient compliance with disease management. Descriptive analyses of the process of care actions, prescribing patterns and lifestyle activities were also undertaken. Various data sources were used in the analysis; test results, Medicare data, case note audit data and medicine and lifestyle questionnaires.
Key Findings
- at a patient level PoCT was found to be non-inferior (the same or better) compared to pathology laboratory testing for HbA1c (p<0.0001), urine albumin (p=0.0040), ACR (p=0.0367), total cholesterol (p<0.0001) and triglycerides (p=0.0001), but not for INR (p=0.2389)and HDL-C (p=0.7723)
- at a test level PoCT was found to be non-inferior (the same or better) compared to pathology laboratory testing for INR (p=0.0008), HbA1c (p<0.0001), urine albumin (p=0.0005), ACR (p=0.0129), total cholesterol (p<0.0001) and triglycerides (p<0.0001), but not for HDL-C (p=0.7862)
- PoCT was found to be non-inferior (the same or better) compared to pathology laboratory testing in relation to the proportion of patients showing an improvement in their test result from baseline for HbA1c (p<0.0001), total cholesterol (p<0.0001) and triglycerides (p=0.0001)
- PoCT patients had significantly more GP visits (p=0.0126) and more testing
- GPs using PoCT recorded more process of care actions than control GPs for all conditions if tests were within target range. Fewer differences were found between actions undertaken by intervention GPs compared to control GPs if tests were outside target range
- PoCT had little impact on GP prescribing patterns for all three conditions
- PoCT was found to be non-inferior (the same or better) compared to pathology laboratory testing in relation to the proportion of questionnaire responses indicating compliance with disease management (medication compliance)
- in terms of lifestyle activities few differences were found between treatment groups.
Key Conclusions
- in terms of therapeutic control, PoCT was found to be the same or better than pathology laboratory testing for most tests, suggesting that PoCT could assist GPs in better management of some chronic conditions
- the results also suggested that having an immediate test result was beneficial for patients in terms of medication compliance.
