Clinician perspectives on having point of care tests made available to them during out of hours home visiting

S Dixon; M Glogowska; S Garland; H Hunt; D Lasserson; G Hayward

doi:10.1186/s12875-021-01571-0

Clinician perspectives on having point of care tests made available to them during out of hours home visiting

BMC Fam Pract. 2021 Dec 16;22(1):246. doi: 10.1186/s12875-021-01571-0.

Authors

S Dixon¹, M Glogowska², S Garland³, H Hunt³, D Lasserson⁴, G Hayward²

Affiliations

¹ Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, England, UK. Sharon.dixon@phc.ox.ac.uk.
² Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, England, UK.
³ Oxford Health Foundation Trust, Warneford Hospital, Warneford Lane, Headington, Oxford, OX3 7JX, England, UK.
⁴ Warwick Medical School, The University of Warwick, Coventry, CV4 7AL, England, UK.

Abstract

Background: Little is known about clinicians' perspectives on the use of point of care (POC) tests in assessment of acute illness during primary care out of hours (OOH) care. During a service improvement project, POC tests (including creatinine, electrolytes, haemoglobin and lactate) were made available to clinicians undertaking OOH home visits, with the clinicians allowed absolute discretion about when and whether they used them.

Method: To explore clinicians' perspectives on having POC tests available during OOH home visits, we undertook a qualitative study with clinicians working in Oxfordshire OOH home visiting teams. We conducted 19 Semi-structured interviews with clinicians working in OOH, including those who had and had not used the POC tests available to them. To explore evolving perspectives over time, including experience and exposure to POC tests, we offered clinicians the opportunity to be interviewed twice throughout the study period. Our sample included 7 GPs (4 interviewed once, 3 interviewed twice - earlier and later during the study), 6 emergency practitioners (EPs) including advanced nurse practitioners and paramedics, 1 Healthcare Assistant, and 2 ambulatory care physicians. Interviews were audio-recorded, transcribed verbatim and analysed thematically.

Results: The clinicians reflected on their decision-making to use (or not use) POC tests, including considering which clinical scenarios were "appropriate" and balancing the resources and time taken to do POC tests against what were perceived as likely benefits. The challenges of using the equipment in patients' homes was a potential barrier, though could become easier with familiarity and experience. Clinicians who had used POC tests described benefits, including planning onward care trajectories, and facilitating communication, both between professionals and with patients and their families.

Conclusion: Clinicians described a discriminatory approach to using POC tests, considering carefully in which situations they were likely to add value to clinical decision-making.

Keywords: Home visit; Near patient tests; Out of hours (OOH); Point of care tests (POC) tests; Primary care urgent care.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

After-Hours Care*
House Calls*
Humans
Point-of-Care Testing
Primary Health Care
Qualitative Research