Abstract
Aim: To investigate general practitioners' (GPs') desire and perceived added value of point-of-care (POC) troponin, its effect on referral decisions, and test requirements.
Background: Excluding acute coronary syndrome (ACS) in primary care remains a diagnostic challenges for GPs. Consequently, referral rates of chest pain patients are high, while the incidence of a cardiovascular problem is only 8-15%. Previous studies have shown that GPs are interested in a POC troponin test. This test could enhance rapid exclusion of ACS, thereby preventing unnecessary patient distress, without compromising safety and while reducing costs. However, using this test is not recommended in current guidelines due to uncertainty in the test's potential added value, and the lower sensitivity early after symptom onset as compared with troponin tests in a regular laboratory.
Methods: An online survey containing 34 questions was distributed among 837 Dutch GPs in June 2015.
Findings: A total of 126 GPs (15.1%) completed at least 75% of the questions. 67.1% of GPs believe that POC troponin tests have moderate to very high added value. Although the availability of a POC test is expected to increase the frequency at which troponin tests are used, it likely decreases (immediate) referral rates. Of the responding GPs, 78.3% only accept 10 min as the maximum test duration, 78.1% think reimbursement of the POC device is required for implementation, and 68.9% consider it necessary that it can be performed with a finger prick blood sample. In conclusion, according to GPs, the POC troponin test can be of added value to exclude ACS early on. Actual test implementation will depend on test characteristics, including test duration, type of blood sample required, and reimbursement of the analyzer.
| Original language | English |
|---|---|
| Pages (from-to) | 386-397 |
| Number of pages | 12 |
| Journal | Primary health care research & development |
| Volume | 18 |
| Issue number | 4 |
| DOIs | |
| Publication status | Published - 1 Jul 2017 |
| Externally published | Yes |
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Keywords
- acute coronary syndrome
- point-of-care systems
- primary health care
- referral and consultation
- surveys and questionnaires
- troponin
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Improving early exclusion of acute coronary syndrome in primary care : The added value of point-of-care troponin as stated by general practitioners. / Kip, Michelle M.A.; Noltes, Amber M.; Koffijberg, Hendrik; IJzerman, Maarten J.; Kusters, Ron.
In: Primary health care research & development, Vol. 18, No. 4, 01.07.2017, p. 386-397.Research output: Contribution to journal › Article › Academic › peer-review
TY - JOUR
T1 - Improving early exclusion of acute coronary syndrome in primary care
T2 - The added value of point-of-care troponin as stated by general practitioners
AU - Kip, Michelle M.A.
AU - Noltes, Amber M.
AU - Koffijberg, Hendrik
AU - IJzerman, Maarten J.
AU - Kusters, Ron
PY - 2017/7/1
Y1 - 2017/7/1
N2 - Aim: To investigate general practitioners' (GPs') desire and perceived added value of point-of-care (POC) troponin, its effect on referral decisions, and test requirements.Background: Excluding acute coronary syndrome (ACS) in primary care remains a diagnostic challenges for GPs. Consequently, referral rates of chest pain patients are high, while the incidence of a cardiovascular problem is only 8-15%. Previous studies have shown that GPs are interested in a POC troponin test. This test could enhance rapid exclusion of ACS, thereby preventing unnecessary patient distress, without compromising safety and while reducing costs. However, using this test is not recommended in current guidelines due to uncertainty in the test's potential added value, and the lower sensitivity early after symptom onset as compared with troponin tests in a regular laboratory.Methods: An online survey containing 34 questions was distributed among 837 Dutch GPs in June 2015.Findings: A total of 126 GPs (15.1%) completed at least 75% of the questions. 67.1% of GPs believe that POC troponin tests have moderate to very high added value. Although the availability of a POC test is expected to increase the frequency at which troponin tests are used, it likely decreases (immediate) referral rates. Of the responding GPs, 78.3% only accept 10 min as the maximum test duration, 78.1% think reimbursement of the POC device is required for implementation, and 68.9% consider it necessary that it can be performed with a finger prick blood sample. In conclusion, according to GPs, the POC troponin test can be of added value to exclude ACS early on. Actual test implementation will depend on test characteristics, including test duration, type of blood sample required, and reimbursement of the analyzer.
AB - Aim: To investigate general practitioners' (GPs') desire and perceived added value of point-of-care (POC) troponin, its effect on referral decisions, and test requirements.Background: Excluding acute coronary syndrome (ACS) in primary care remains a diagnostic challenges for GPs. Consequently, referral rates of chest pain patients are high, while the incidence of a cardiovascular problem is only 8-15%. Previous studies have shown that GPs are interested in a POC troponin test. This test could enhance rapid exclusion of ACS, thereby preventing unnecessary patient distress, without compromising safety and while reducing costs. However, using this test is not recommended in current guidelines due to uncertainty in the test's potential added value, and the lower sensitivity early after symptom onset as compared with troponin tests in a regular laboratory.Methods: An online survey containing 34 questions was distributed among 837 Dutch GPs in June 2015.Findings: A total of 126 GPs (15.1%) completed at least 75% of the questions. 67.1% of GPs believe that POC troponin tests have moderate to very high added value. Although the availability of a POC test is expected to increase the frequency at which troponin tests are used, it likely decreases (immediate) referral rates. Of the responding GPs, 78.3% only accept 10 min as the maximum test duration, 78.1% think reimbursement of the POC device is required for implementation, and 68.9% consider it necessary that it can be performed with a finger prick blood sample. In conclusion, according to GPs, the POC troponin test can be of added value to exclude ACS early on. Actual test implementation will depend on test characteristics, including test duration, type of blood sample required, and reimbursement of the analyzer.
KW - acute coronary syndrome
KW - point-of-care systems
KW - primary health care
KW - referral and consultation
KW - surveys and questionnaires
KW - troponin
UR - http://www.scopus.com/inward/record.url?scp=85018413117&partnerID=8YFLogxK
U2 - 10.1017/S1463423617000135
DO - 10.1017/S1463423617000135
M3 - Article
VL - 18
SP - 386
EP - 397
JO - Primary health care research & development
JF - Primary health care research & development
SN - 1463-4236
IS - 4
ER -