Barriers Affecting the Adoption of Point-of-Care Technologies Used in Chest Pain Diagnosis Within the UK National Health Service: Part 1-User Issues

An assessment of the user issues impeding the uptake and adoption of cardiac marker point-of-care testing (POCT) deployed in chest pain diagnosis within the United Kingdom-Northern Ireland National Health Service (NHS) acute health care system was carried out via a structured Web-based survey. The study presents the views and opinions from 100 health care professional survey respondents (clinicians, nurses, and laboratory scientists) at 10 major hospitals within all 5 Northern Ireland NHS Trusts. It also suggests a means by which these user-perceived adoption barriers could be overcome to facilitate better POCT implementation. Of the 100 survey responses received, 28 were from actual end users of cardiac marker POCT, whereas the remainder were from specialists in related fields with direct knowledge of the device platforms concerned. The uptake and adoption of POCT in the UK NHS for use in the emergency department during chest pain diagnosis is affected by several user-related issues including cost/test, consumable cost, quality assurance, International Standards Organization accreditation, clinical governance, training, and safety. Health technology assessment (HTA) can provide useful evidence to UK health procurement agencies, manufacturers, and purchasers of the value and benefits of POCT in terms of improving clinical and health economic outcomes and in supporting health care procurement and reimbursement policy decisions. The most frequently reported point-of-care devices among UK-Northern Ireland NHS respondents were the Biosite Triage and Dade Behring Stratus CS. Point-of-care testing uptake drivers among clinician, nursing, and laboratory users within UK-Northern Ireland Health Trusts included patient convenience and demand and improved clinical management. Clinician, nursing, and laboratory users indicated that these drivers were not influenced by financial profit or NHS government policy. This suggests that UK central government NHS policy drivers are not readily absorbed at the operational level within the regional Northern Ireland NHS. Issues such as cost/test were perceived as significant barriers to POCT uptake in the NHS by clinician and nursing survey respondents, in addition to quality assurance, training, safety, and accreditation. Point-of-care testing consumable costs were scored higher by laboratory respondents as an uptake barrier, together with quality assurance, training, and safety issues, although accreditation was perceived less so. Generally improved quality assurance measures such as International Standards Organization 22870 accreditation and better training and safety were perceived by all respondents as significant POCT enhancement factors contributing to satisfying NHS departmental and Health Trust clinical governance. User respondents within Northern Ireland NHS Health Trusts indicated the vital role of POCT coordinators within the NHS in planning and regulating POCT implementation.