Point of Care persevering Testing

Point of Care Patient Testing



The use of Glucose INR point-of-care testing

Introduction

Point-of-care testing (POCT) is increasingly being used in general practice to assist GPs in their management of patients with diseases. An accredited external quality assessment (EQA) program and internal quality control system is recommended1. In the Copenhagen area external as well as internal quality control has been enforced by annual outreach consultant visits and by split sample EQA procedures, where POCT results have been compared with central laboratory results. However, the adherence to quality guidelines has been seen to be less than anticipated among GPs in the Copenhagen municipality and in the former county of Copenhagen.

Dissemination of guidelines alone rarely brings about improvements in clinical practice2 and even an multifaceted implementation of guidelines may not change clinical practice.

Multiple schemes for implementing guidelines emerge to be more effective than lone ones. although, well-designed empirical study looking into diverse implementation schemes is still required in this area.

E-mails have successfully been used in several studies to promote health behaviour change in risk populations 8;9 and our hypothesis is that electronic reminder letters (send to the GPs electronic patient records) is an efficient and inexpensive way to influence the behaviour of GP's.

Due to the low adherence, the Copenhagen General Practitioners' Laboratory (CGPL) plans to introduce electronic reminder letters (alongside the standard implementation procedures) during 2010 in order to increase adherence to the quality guideline.

The aims of this study are:

To evaluate the effect of electronic reminder letters on general practices adherence to clinical quality guidelines regarding POCT.

To evaluate the legacy effect of a potential effect of reminder letters (i.e. the impact of the intervention after it has stopped).

Participants Included in the study are all, approximately 320, GP practices conducting POCT at least four POCT (either haemoglobin or glucose) during a 4 month before study period and not conducting INR analysis (defined as four or less tests during 4 four months period).

These practices were identified in the GP database of the Capital area and by the CGPL.

Data collection Data on performed split test EQA procedures is retrieved from CGPL database.

These data do not contain any patient related data because all split test EQA are conducted by a constructed identification code. Process indicators (sent reminder letters) are also obtained from CGPL. KvEAP and Capital Region databases provide information on the participating practices and corresponding GPs.

Data from The Capital Region Information regarding: Sex, age, year of graduation from university, working address, type of practice, patient listed to practice and use the following tests: Hemoglobin, Glucose, INR; CRP, HbA1C were retrospectively collected 6 months before the start of the trial (tentative in order to establish a baseline). Each month in the remainder of the study period we receive data from the Capital Region regarding practices in the study areas and identify practices having used Hemoglobin or blood Glucose as a POCT. These data will be compared with the CGPL database every month and those practices that have not done a split sample EQA ...