Utilisation of remote capillary blood testing in an outpatient clinic setting to improve shared decision making and patient and clinician experience: a validation and pilot study

BMJ Open Quality

article

Lisa Nwankwo¹  Kate McLaren²  Jackie Donovan³  Zhifang Ni⁴  Alberto Vidal-Diaz⁴  Michael Loebinger²  Alice Morrisey⁶  Adam Igra¹  Anand Shah² 

[1] Pharmacy , Royal Brompton and Harefield NHS Foundation Trust;Department of Respiratory Medicine , Royal Brompton and Harefield NHS Foundation Trust;Department of Pathology , Royal Brompton and Harefield NHS Foundation Trust;Faculty of Medicine, Department of Surgery and Cancer , Imperial College London;National Heart and Lung Institute;Royal Brompton and Harefield NHS Foundation Trust;MRC Centre of Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, School of Public Health , Imperial College

关键词: health services research;    laboratory medicine;    quality improvement;    PDSA;    outpatients;   

DOI  :  10.1136/bmjoq-2020-001192

学科分类：药学

来源: BMJ Publishing Group

【 摘 要 】

Background In a tertiary respiratory centre, large cohorts of patients are managed in an outpatient setting and require blood tests to monitor disease activity and organ toxicity. This requires either visits to tertiary centres for phlebotomy and physician review or utilisation of primary care services.Objectives This study aims to validate remote capillary blood testing in an outpatient setting and analyse impact on clinical pathways.Methods0.8% and 95% of tests within 10% difference through Bland-Altman (limits of agreement). In parallel, current clinical pathways including phlebotomy practice were analysed over 4 weeks to review test predictability. A subsequent pilot cohort study analysed potential impact of remote capillary blood sampling on shared decision making. A final implementation phase ensued to embed the service into clinical pathways within the institution.Results 117 paired capillary and venous blood samples were prospectively analysed. Interchangeability with venous blood was seen with glycated haemoglobin (%), total protein and C reactive protein. Further tests, although not interchangeable, are likely useful to enable longitudinal remote monitoring (eg, liver function and total IgE). 65% of outpatient clinic blood tests were predictable with 16% of patients requiring further follow-up. Patient and clinician-reported improvement in shared decision making given contemporaneous blood test results was observed.Conclusions Remote capillary blood sampling can be used accurately for specific tests to monitor chronic disease, and when incorporated into an outpatient clinical pathway can improve shared decision making and patient experience. Further research is required to determine health economic impact and applicability within telemedicine-based outpatient care.

【 授权许可】

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