Mapping patient pathways and estimating resource use for point of care versus standard testing and treatment of chlamydia and gonorrhoea in genitourinary medicine clinics in the UK
Mapping patient pathways and estimating resource use for point of care versus standard testing and treatment of chlamydia and gonorrhoea in genitourinary medicine clinics in the UK
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DOI：
10.1136/bmjopen-2014-005322
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发表时间：
2014-01-01
期刊：
影响因子：
2.9
通讯作者：
Horner, Patrick
中科院分区：
文献类型：
--
作者：
Adams, Elisabeth J.;Ehrlich, Alice;Horner, Patrick
目标：我们旨在使用衣原体/淋病即时护理 (POC) 核酸扩增测试 (NAAT) 探索患者路径，并估计和比较拟议的 POC 路径与使用标准实验室 NAAT 测试的当前路径的成本。 设计/参与者：在代表英国不同护理模式的四个性健康诊所与医疗保健专业人员一起举办了研讨会。他们绘制了当前使用衣原体/淋病测试的途径，并使用 POC NAAT 构建了新的途径。医疗保健专业人员在每个途径中的时间均进行了评估。结果衡量：然后使用 Microsoft Excel 中构建的模型对拟议的 POC 途径进行定价，并与之前发布的在场外实验室使用基于标准 NAAT 的测试的途径的成本进行比较。结果：对无症状和有症状患者使用 POC NAAT 以及仅衣原体/淋病检测的途径比大多数当前途径更短且更便宜。值得注意的是，我们估计，将 POC 检测作为有症状患者性健康筛查的一部分，或者作为独立的衣原体/淋病检测，可以分别降低每位患者多达 16 或 6 的成本。在这两种情况下，医疗保健专业人员为每位患者节省的时间大约为 10 分钟。结论：在临床环境中对衣原体/淋病进行 POC 检测可以减少成本和临床医生的时间，并可能为患者提供更适当、更快速的护理。需要进一步研究如何在诊所中最好地实施 POC 测试，以及该技术更广泛的临床和成本影响。
Objectives: We aimed to explore patient pathways using a chlamydia/gonorrhoea point-of-care (POC) nucleic acid amplification test (NAAT), and estimate and compare the costs of the proposed POC pathways with the current pathways using standard laboratory-based NAAT testing.Design/participants: Workshops were conducted with healthcare professionals at four sexual health clinics representing diverse models of care in the UK. They mapped out current pathways that used chlamydia/gonorrhoea tests, and constructed new pathways using a POC NAAT. Healthcare professionals' time was assessed in each pathway.Outcome measure: The proposed POC pathways were then priced using a model built in Microsoft Excel, and compared to previously published costs for pathways using standard NAAT-based testing in an off-site laboratory.Results: Pathways using a POC NAAT for asymptomatic and symptomatic patients and chlamydia/gonorrhoea-only tests were shorter and less expensive than most of the current pathways. Notably, we estimate that POC testing as part of a sexual health screen for symptomatic patients, or as stand-alone chlamydia/gonorrhoea testing, could reduce costs per patient by as much as 16 or 6, respectively. In both cases, healthcare professionals' time would be reduced by approximately 10 min per patient.Conclusions: POC testing for chlamydia/gonorrhoea in a clinical setting may reduce costs and clinician time, and may lead to more appropriate and quicker care for patients. Further study is warranted on how to best implement POC testing in clinics, and on the broader clinical and cost implications of this technology.