Patterns of point-of-care test use among obstetricians and gynaecologists in the US
Anne M. Rompalo A D , Neko Castleberry B , Lea Widdice C , Jay Schulkin B and Charlotte A. Gaydos AA Department of Medicine, Division of Infectious Diseases, Johns Hopkns Medical Institutions, 5200 Eastern Avenue, Mason F. Lord Center Tower, 3rd floor Infectious Diseases Suite, Baltimore, MD, 21223, USA.
B The American College of Obstetricians and Gynecologists, 409 12th St SW, Washington, DC, 20024, USA.
C Division of Adolescent Medicine, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA.
D Corresponding author. Email: arompalo@jhmi.edu
Sexual Health 15(4) 318-324 https://doi.org/10.1071/SH17180
Submitted: 26 September 2017 Accepted: 25 January 2018 Published: 19 June 2018
Abstract
Background: Point-of-care tests (POCTs) for reproductive health conditions have existed for decades. Newer POCTs for syphilis, HIV and trichomonas are currently available and easy to use. We surveyed practicing obstetricians and gynaecologists to determine current POCT use and perceived obstacles to use. Methods: Between June and August 2016, 1000 members of the American College of Obstetricians and Gynecologists were randomly selected and invited to complete a Qualtrics (222 West river Park Drive, Provo, Utah 84604, USA) survey; 600 of these were members of the Collaborative Ambulatory Research Network. Respondents who completed at least 60% of the survey were included in the analysis. Results: Of the 1000 selected members, 749 had valid emails and 288 (38%) of these participated in and completed the survey. Of the respondents, 70% were male with a mean of 18 years in practice. Detection of sexually transmissible infections (STIs) once or twice a week was reported by 30%, whereas 45% reported detecting STIs once or twice a month. POCTs used included pregnancy tests (83%), urine dipstick (83%), wet mount tests (79%) and the vagina pH test (54.8%). Few used Gram stain (5%) and stat rapid plasma regain tests (4%). Relatively newer US Food and Drug Administration-approved POCTs were used less frequently, with 25% of respondents reporting using the Affirm VPIII (Becton, Dickinson and Company, 1 Becton Drive, Franklin Lakes, NJ 07471, USA) test use and only 10% using a rapid HIV test. The most common perceived barriers to testing were the amount of reimbursement received for performing the test (61.9%) and the payment coverage from the patient (61.3%). Conclusions: US obstetricians and gynaecologists rely on laboratory test results and traditional POCTs to diagnosis STIs. Future development and marketing of POCTs should consider not only ease and time of test performance, but also the cost of the tests to the practice and the patient, as well as reimbursement.
Additional keywords: near-patient diagnosis, reproductive health, sexually transmitted infections.
References
[1] Herbst de Cortina S, Bristow CC, Duvey DJ, Klausner JD. A systematic review of point of care testing for Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis. Infect Dis Obstet Gynecol 2016; 2016 4386127| A systematic review of point of care testing for Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis.Crossref | GoogleScholarGoogle Scholar |
[2] Drancourt M, Michell-Lepage A, Boyer S, Raoult D. The point-of-care laboratory in clinical microbiology. Clin Microbiol Rev 2016; 29 429–47.
| The point-of-care laboratory in clinical microbiology.Crossref | GoogleScholarGoogle Scholar |
[3] Cristillo AD, Bristow CC, Peeling R, Van Der Pol B, De Cortina SH, Dimov IK, Pai NP, Jin Shin D, Chiu RY, Klapperich C, Madhivanan P, Morris SR, Klausner JD. Point-of-care sexually transmitted infection diagnostics: Proceedings of the STAR sexually transmitted infection- clinical trial group programmatic meeting. Sex Trans Dis 2017; 44 211–18.
[4] Tucker JD, Bien CH, Peeling RW. Point-of-care testing for sexually transmitted infections: recent advances and implications for disease control. Curr Opin Infect Dis 2013; 26 73–9.
| Point-of-care testing for sexually transmitted infections: recent advances and implications for disease control.Crossref | GoogleScholarGoogle Scholar |
[5] Hsieh YH, Gaydos CA, Hogan MT, Uy OM, Jackman J, Jett-Goheen M, Alberti A, Dangerfield DT, Neustadt CR, Wiener ZS, Rompalo AM. What qualities are most important to making a point of care test desirable for clinicians and others offering sexually transmitted infection testing? PLoS One 2011; 6 e1926
| What qualities are most important to making a point of care test desirable for clinicians and others offering sexually transmitted infection testing?Crossref | GoogleScholarGoogle Scholar |
[6] Rompalo AM, Hsieh YH, Hogan T, Barnes M, Jett-Goheen M, Huppert JS, Gsydos CA. Point-of-care tests for sexually transmissible infections: what do ‘end users’ want? Sex Health 2013; 10 541–5.
| Point-of-care tests for sexually transmissible infections: what do ‘end users’ want?Crossref | GoogleScholarGoogle Scholar |
[7] Su WH, Tsou TS, Chen CS. Are we satisfied with the tools for the diagnosis of gonococcal infection in females? J Chin Med Assoc 2011; 74 430–4.
| Are we satisfied with the tools for the diagnosis of gonococcal infection in females?Crossref | GoogleScholarGoogle Scholar |
[8] Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance 2016. Atlanta: U.S. Department of Health and Human Services; 2017.
[9] Coleman VH, Power ML, Zinbers S, Schulkin J. Contemporary clinical issues in outpatient obstetrics and gynecology: findings of the Collaborative Ambulatory Research Network, 2001–2001: part 1. Obstet Gynecol Surv 2004; 59 780–6.
| Contemporary clinical issues in outpatient obstetrics and gynecology: findings of the Collaborative Ambulatory Research Network, 2001–2001: part 1.Crossref | GoogleScholarGoogle Scholar |
[10] Ford Carleton P, Schachter S, Parrish JA, Collins JM, Crocker JB, Dixon RF, Edgman-Levitan S, Lewandrowski KB, Stahl JE, Klapperich C, Cabodi M, Gaydos CA, Rompalo Am, Manabe Y, Wang TH, Rothman R, Geddes CD, Widdice L, Jackman J, Mathura RA, Lash TB. National Institute of Biomedical Imaging and Bioengineering point-of-care technology research network: advancing precision medicine. IEEE J Transl Eng Health Med 2016; 4 1–14.
| National Institute of Biomedical Imaging and Bioengineering point-of-care technology research network: advancing precision medicine.Crossref | GoogleScholarGoogle Scholar |
[11] Brook G. the performance of non-NAAT point-of-care (POC) tests and rapid NAATS tests for chlamydia and gonorrhoea infections. An assessment of currently available assays. Sex Transm Infect 2015; 91 539–44.
| the performance of non-NAAT point-of-care (POC) tests and rapid NAATS tests for chlamydia and gonorrhoea infections. An assessment of currently available assays.Crossref | GoogleScholarGoogle Scholar |
[12] Reed JL, Simendinger L, Griffeth S, Kim HG, Huppert JS. Point-of-care testing for sexually transmitted infections increases awareness and short-term abstinence in adolescent women. J Adolesc Health 2010; 46 270–7.
| Point-of-care testing for sexually transmitted infections increases awareness and short-term abstinence in adolescent women.Crossref | GoogleScholarGoogle Scholar |
[13] Schwebke JR, Sadler R, Sutton JM, Hook EW. Positive screening tests for gonorrhea and chlamydial infection fail to lead consistently to treatment of patients attending a sexually transmitted diseases clinic. Sex Transm Dis 1997; 24 181–4.
| Positive screening tests for gonorrhea and chlamydial infection fail to lead consistently to treatment of patients attending a sexually transmitted diseases clinic.Crossref | GoogleScholarGoogle Scholar |
[14] Scholes D, Stergachis A, Heidrich FE, Andrilla H, Holmes KK, Stamm WE. Prevention of pelvic inflammatory disease by screening for cervical chlamydial infection. N Engl J Med 1996; 334 1362–6.
| Prevention of pelvic inflammatory disease by screening for cervical chlamydial infection.Crossref | GoogleScholarGoogle Scholar |
[15] Peeling RW, Holmes KK, Maabey D, Ronald A. Rapid tests for sexually transmitted infections (STIs): the way forward. Sex Transm Infect 2006; 82 v1–6.
| Rapid tests for sexually transmitted infections (STIs): the way forward.Crossref | GoogleScholarGoogle Scholar |
[16] World Health Organization. Global health sector strategy on sexually transmitted infections 2016–2021: towards ending STIs. 2016. Available online at: http://apps.who.int/iris/bitstream/10665/246296/1/WHO-RHR-16.09-eng.pdf?ua=1 [verified 21 May 2018].
[17] Turner KME, Round J, Horner P, Macleod J, Goldenberg S, Deol A, Adams EJ. An early evaluation of clinical and economic costs and benefits of implementing point of care NAATS for Chlamydia trachomatis and Neisseria gonorrhoeae in genitourinary medicine clinics in England. Sex Transm Infect 2014; 90 104–11.
| An early evaluation of clinical and economic costs and benefits of implementing point of care NAATS for Chlamydia trachomatis and Neisseria gonorrhoeae in genitourinary medicine clinics in England.Crossref | GoogleScholarGoogle Scholar |
[18] Huang W, Gaydos CA, Barner MR, Jwett-Goheen M, Blake DD. Comparative effectiveness of a rapid point-of-care test for detection of Chlamydia trachomatis among women in a clinical setting. Sex Transm Infect 2013; 89 108–14.
| Comparative effectiveness of a rapid point-of-care test for detection of Chlamydia trachomatis among women in a clinical setting.Crossref | GoogleScholarGoogle Scholar |
