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Point-of-care testing in India: missed opportunities to realize the true potential of point-of-care testing programs
BACKGROUND: The core objective of any point-of-care (POC) testing program is to ensure that testing will result in an actionable management decision (e.g. referral, confirmatory test, treatment), within the same clinical encounter (e.g. POC continuum). This can but does not have to involve rapid tes...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2015
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4677441/ https://www.ncbi.nlm.nih.gov/pubmed/26652014 http://dx.doi.org/10.1186/s12913-015-1223-3 |
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author | Engel, Nora Ganesh, Gayatri Patil, Mamata Yellappa, Vijayashree Vadnais, Caroline Pai, Nitika Pant Pai, Madhukar |
author_facet | Engel, Nora Ganesh, Gayatri Patil, Mamata Yellappa, Vijayashree Vadnais, Caroline Pai, Nitika Pant Pai, Madhukar |
author_sort | Engel, Nora |
collection | PubMed |
description | BACKGROUND: The core objective of any point-of-care (POC) testing program is to ensure that testing will result in an actionable management decision (e.g. referral, confirmatory test, treatment), within the same clinical encounter (e.g. POC continuum). This can but does not have to involve rapid tests. Most studies on POC testing focus on one specific test and disease in a particular healthcare setting. This paper describes the actors, technologies and practices involved in diagnosing major diseases in five Indian settings – the home, community, clinics, peripheral laboratories and hospitals. The aim was to understand how tests are used and fit into the health system and with what implications for the POC continuum. METHODS: The paper reports on a qualitative study including 78 semi-structured interviews and 13 focus group discussions with doctors, nurses, patients, lab technicians, program officers and informal providers, conducted between January and June 2013 in rural and urban Karnataka, South India. Actors, diseases, tests and diagnostic processes were mapped for each of the five settings and analyzed with regard to whether and how POC continuums are being ensured. RESULTS: Successful POC testing hardly occurs in any of the five settings. In hospitals and public clinics, most of the rapid tests are used in laboratories where either the single patient encounter advantage is not realized or the rapidity is compromised. Lab-based testing in a context of manpower and equipment shortages leads to delays. In smaller peripheral laboratories and private clinics with shorter turn-around-times, rapid tests are unavailable or too costly. Here providers find alternative measures to ensure the POC continuum. In the home setting, patients who can afford a test are not/do not feel empowered to use those devices. CONCLUSION: These results show that there is much diagnostic delay that deters the POC continuum. Existing rapid tests are currently not translated into treatment decisions rapidly or are not available where they could ensure shorter turn-around times, thus undermining their full potential. To ensure the success of POC testing programs, test developers, decision-makers and funders need to account for such ground realities and overcome barriers to POC testing programs. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12913-015-1223-3) contains supplementary material, which is available to authorized users. |
format | Online Article Text |
id | pubmed-4677441 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2015 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-46774412015-12-15 Point-of-care testing in India: missed opportunities to realize the true potential of point-of-care testing programs Engel, Nora Ganesh, Gayatri Patil, Mamata Yellappa, Vijayashree Vadnais, Caroline Pai, Nitika Pant Pai, Madhukar BMC Health Serv Res Research Article BACKGROUND: The core objective of any point-of-care (POC) testing program is to ensure that testing will result in an actionable management decision (e.g. referral, confirmatory test, treatment), within the same clinical encounter (e.g. POC continuum). This can but does not have to involve rapid tests. Most studies on POC testing focus on one specific test and disease in a particular healthcare setting. This paper describes the actors, technologies and practices involved in diagnosing major diseases in five Indian settings – the home, community, clinics, peripheral laboratories and hospitals. The aim was to understand how tests are used and fit into the health system and with what implications for the POC continuum. METHODS: The paper reports on a qualitative study including 78 semi-structured interviews and 13 focus group discussions with doctors, nurses, patients, lab technicians, program officers and informal providers, conducted between January and June 2013 in rural and urban Karnataka, South India. Actors, diseases, tests and diagnostic processes were mapped for each of the five settings and analyzed with regard to whether and how POC continuums are being ensured. RESULTS: Successful POC testing hardly occurs in any of the five settings. In hospitals and public clinics, most of the rapid tests are used in laboratories where either the single patient encounter advantage is not realized or the rapidity is compromised. Lab-based testing in a context of manpower and equipment shortages leads to delays. In smaller peripheral laboratories and private clinics with shorter turn-around-times, rapid tests are unavailable or too costly. Here providers find alternative measures to ensure the POC continuum. In the home setting, patients who can afford a test are not/do not feel empowered to use those devices. CONCLUSION: These results show that there is much diagnostic delay that deters the POC continuum. Existing rapid tests are currently not translated into treatment decisions rapidly or are not available where they could ensure shorter turn-around times, thus undermining their full potential. To ensure the success of POC testing programs, test developers, decision-makers and funders need to account for such ground realities and overcome barriers to POC testing programs. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12913-015-1223-3) contains supplementary material, which is available to authorized users. BioMed Central 2015-12-14 /pmc/articles/PMC4677441/ /pubmed/26652014 http://dx.doi.org/10.1186/s12913-015-1223-3 Text en © Engel et al. 2015 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Article Engel, Nora Ganesh, Gayatri Patil, Mamata Yellappa, Vijayashree Vadnais, Caroline Pai, Nitika Pant Pai, Madhukar Point-of-care testing in India: missed opportunities to realize the true potential of point-of-care testing programs |
title | Point-of-care testing in India: missed opportunities to realize the true potential of point-of-care testing programs |
title_full | Point-of-care testing in India: missed opportunities to realize the true potential of point-of-care testing programs |
title_fullStr | Point-of-care testing in India: missed opportunities to realize the true potential of point-of-care testing programs |
title_full_unstemmed | Point-of-care testing in India: missed opportunities to realize the true potential of point-of-care testing programs |
title_short | Point-of-care testing in India: missed opportunities to realize the true potential of point-of-care testing programs |
title_sort | point-of-care testing in india: missed opportunities to realize the true potential of point-of-care testing programs |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4677441/ https://www.ncbi.nlm.nih.gov/pubmed/26652014 http://dx.doi.org/10.1186/s12913-015-1223-3 |
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