This thesis presents the findings from a detailed study of possible barriers to adoption of Pointof-Care Testing (POCT) within hospital-based healthcare. The issues concerned have been identified and categorised from a systematic review of the published literature over the period 2000-2016. The opinions of clinicians working in the UK have been obtained via face-to-face interviews and an online survey tool using semi-quantitative techniques by way of subsequent analysis. These data have then been compared with the outcomes from interviews with those employed in the US healthcare system. Based on these findings, a more targeted appraisal of the opinions of international Clinical Bioscientists was then undertaken. Overall, the central aim of the work was to categorise and better understand the core issues that have been identified as impeding the clinical uptake of POCT in both the UK and internationally. Importantly, the focus of the work was on how the most significant barriers can be overcome based on this new understanding of the circumstances. There is a clear disconnect between the opinions of those responsible for operating POCT and those responsible for test data quality assurance, i.e. the Clinical Bioscientists, regardless of location. In particular, it was found that this relates mostly to specific quality-related issues, including the complexity of regulatory requirements and control of diagnostic testing. While economic issues were generally found to impact most significantly upon POCT adoption, it is indicated that the role of the medical insurer within the US healthcare system acts as an additional hurdle as compared to the situation in the UK (NHS). Based on the research findings described herein a number of recommendations are made for overcoming the various barriers to POCT adoption in hospital-based healthcare, including; development of a sufficient evidence base for the clinical/economic benefits; development of regional procurement strategies; improved connectivity to the patient record systems; improved training processes; increased central laboratory service support, and; improved quality assurance processes.
- Near patient testing
- Hospital-based care