Improving early exclusion of acute coronary syndrome in primary care: The added value of point-of-care troponin as stated by general practitioners

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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 languageEnglish
Pages (from-to)386-397
Number of pages12
JournalPrimary health care research & development
Volume18
Issue number4
DOIs
Publication statusPublished - 1 Jul 2017
Externally publishedYes

Fingerprint

Point-of-Care Systems
Troponin
Acute Coronary Syndrome
General Practitioners
Primary Health Care
Referral and Consultation
Hematologic Tests
Chest Pain
Fingers
Uncertainty
Guidelines
Safety
Costs and Cost Analysis
Equipment and Supplies
Incidence

Keywords

  • acute coronary syndrome
  • point-of-care systems
  • primary health care
  • referral and consultation
  • surveys and questionnaires
  • troponin

Cite this

@article{3a3cda611a5f4900b4013f1ef43f4aed,
title = "Improving early exclusion of acute coronary syndrome in primary care: The added value of point-of-care troponin as stated by general practitioners",
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.",
keywords = "acute coronary syndrome, point-of-care systems, primary health care, referral and consultation, surveys and questionnaires, troponin",
author = "Kip, {Michelle M.A.} and Noltes, {Amber M.} and Hendrik Koffijberg and IJzerman, {Maarten J.} and Ron Kusters",
year = "2017",
month = "7",
day = "1",
doi = "10.1017/S1463423617000135",
language = "English",
volume = "18",
pages = "386--397",
journal = "Primary health care research & development",
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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.

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KW - point-of-care systems

KW - primary health care

KW - referral and consultation

KW - surveys and questionnaires

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DO - 10.1017/S1463423617000135

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VL - 18

SP - 386

EP - 397

JO - Primary health care research & development

JF - Primary health care research & development

SN - 1463-4236

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