Special Interest Group on Global Point of Care Testing annual report

Introduction:
The WONCA Special Interest Group on Global Point-of-Care Testing was approved by the WONCA World Council in Prague in June 2013.

Executive Membership:
The Executive Members of the SIG representing all of WONCA’s seven regions are as follows:
• Prof Mark Shephard, Asia Pacific (Chair)
• Tessa McCormack, Asia Pacific (Secretary)
• Dr Anthony Omolola, Africa
• Dr Ndi Okwuosa, Africa
• Assoc Prof Bohumil Seifert, Europe
• Dr Cristina Isar, Europe
• Dr Tim Kolotyluk, North America
• Dr Raman Kumar, South Asia
• Dr Jose’ Carlos Prado Junior, Iberoamericana
• Dr Dalal AlArfaj, East Mediterranean
• Dr Igor Toskin, Europe (WHO Observer)

General Membership:
General membership is open to interested family doctors and to date 79 members from 41 countries representing all seven WONCA regions have joined the SIG.
> Join here

Activities:

• Continuing Survey regarding POCT in WONCA practices (see update below)
• 5 January 2015 - First SIG POCT newsletter sent to 75 members
• 6 January 2015 - Dr Dalal AlArfaj accepted as Executive Member representing East Mediterranean
• 8 February 2015 - accessArticle on survey published in WONCA news
• 16 April 2015 - Professor Shephard presented POCT workshop at WONCA World Rural Health Conference in Dubrovnik
• May to June (Ongoing) - Professor Shephard has started dialogue with Dr Rich Withnall from the WONCA SIG on Catastrophe and Conflict Medicine about collaborative activities between the two SIGs

Survey regarding point-of-care testing in WONCA practices

During 2014, the SIG launched an online survey on point-of-care testing (POCT) and Executive and General Members were asked to disseminate the link to their family doctor colleagues. The purpose of the survey is to obtain a wide understanding of the clinical use, availability, needs, advantages, and limitations or barriers to the implementation of point-of-care testing across all WONCA regions of the world. This information will continue to inform the SIG on priorities for education and research.

Results (as of 4 August 2015):
• 113 responses have been received representing all 7 WONCA regions, with two-thirds of respondents from Europe.
• 90% of respondents are Family Doctors.
• 80% of respondents are currently using POCT in their practices.
• POCT is being performed by doctors (57%), nurses and nurse practitioners (67%) and laboratory professionals (38%).
• 55% of respondents perform quality testing to support POCT in their practices.
• The most common POC tests used in the respondents’ practices are glucose (95%), urinalysis (77%), HbA1c (74%), haemoglobin (63%) and Hepatitis B/C (67%).
• When asked which POC tests respondents would like to have available for their use, 74% said that they would like to have HbA1c testing available by POC. Other tests that 50% or more respondents would like to have available are blood alcohol levels, drugs of abuse, full blood count, INR, C-reactive protein, electrolytes, glucose, cardiac markers, HIV, chlamydia, HBV and HCV.
• The most commonly reported attributes of POCT were rapid diagnosis and/or treatment (93%), convenience for patient (77%), ease of use (65%) and improved doctor-patient relationship (62%) (Figure 1).
• 98% of respondents reported one or more barriers to the implementation of POCT. The three most commonly reported barriers related to the cost of POCT (81%), lack of Government reimbursement (51%) and staffing issues (38%).
• Regarding government regulations and support, only 28% of respondents stated that their country had standards or guidelines for the conduct of POCT, had access to quality assurance programs, and had an accreditation framework for POCT. Just over 40% stated that their local laboratory provided support for POCT.

The survey continues to be open for responses from WONCA Family Doctors and their health professional colleagues. It is the intention of the SIG to publish the results of the survey in an international peer-reviewed journal across the next year.

Report on SIG Workshop on POCT held in Dubrovnik, April 2015

A workshop entitled ‘Barriers to Access of Quality Point-of-Care Testing for Family Doctors’ was presented by Professor Mark Shephard on behalf of the WONCA Special Interest Group on Global Point-of-Care Testing at the 13th WONCA World Rural Health Conference in Dubrovnik, Croatia, held during mid-April 2015. (see photo of Mark speaking)

At the Workshop, Professor Shephard (Chair of the SIG on Global POCT) gave a brief presentation which covered the following topics to set the scene for the Workshop: (i) an overview of the common principles that should be applied when establishing and maintaining a POCT service in a rural family practice setting, (ii) gave selected examples of successful POCT networks in primary care settings, (iii) provided an overview of the SIG’s activities to date (iv) summarised the current findings of the WONCA SIG’s Survey on POCT, particularly in relation to barriers to POCT identified by family doctors who had completed the survey to date, and (v) provided a synthesis of the recent published literature concerning barriers to the implementation of POCT in family medicine.

There were some common themes between results of the WONCA survey and the published literature including (a) the cost of supporting POCT in a family practice setting without access to reimbursement and (b) lingering concerns over the accuracy of POCT.

The major focus of the workshop was a discussion of barriers to accessing POCT in rural and remote family practices.

The workshop was attended by 20 participants including 6 from the host nation Croatia, as well as participants from Macedonia, USA, Sweden, Norway, Japan, UK and Australia. For the group discussion session, participants were split into three small (regional) groups who engaged in active conversation and then reported back to the full audience.

Group one from Croatia prepared a wish list for POC tests that they would like to have available in their country. Most participants identified C-reactive protein, HbA1c, troponin, INR, micro-albumin and streptococcus as POC tests that are most in demand. The main barriers to accessing POCT identified by this group included lack of education, knowledge and awareness of the scope of POCT (which could be addressed by the WONCA SIG); resistance among the laboratory fraternity to support POCT in primary care in their country; the high costs of POCT without government rebates and the lack of evidence on the cost effectiveness of POCT. The second group, which comprised members from the Asia-Pacific region, also felt the cost of POCT consumables such as quality control materials was high and that these costs needed to be reduced through pressure from the general practice community. They also mentioned the strain on staff time to perform POCT and pressure from the laboratory sector were inhibiting the uptake of POCT in primary care settings like family medicine. The third group from North America and Scandinavia felt issues with administrative aspects of POCT including the need for detailed documentation of POCT processes and accreditation requirements impeded the uptake of POCT, as well as the lack of financial reimbursement. The Workshop was conducted in a spirit of collegiality and with a positive will to improve access to POCT across WONCA family practices globally.

During the conference, eight new members joined the SIG on Global POCT.

For more information or to join the SIG, visit the WONCA SIG on Point-of-Care Testing. Please click here to access the short survey on POCT.

Second SIG Newsletter

The second newsletter for SIG members will be prepared during the next reporting period.

Expression of Interest to continue as Chair and Secretariat of SIG

The current Chair and Secretary of the SIG would like to express their interest in continuing in these roles for a second term, and we will be writing to the SIG general membership to seek their support.

Report prepared by
Professor Mark Shephard (Chair) and Tessa McCormack (Secretary),
WONCA SIG on POCT