Point-of-Care Testing – A Quick Win Damned by EBM

The decision by our Department of Health not to fund point-of-care testing is a perfect example of how healthcare is stunted by regulation and our concern for evidence in a world evolving faster than we can think – let alone publish systematic reviews.

Point-of-care (PoC) laboratory testing has numerous advantages over the traditional large-scale laboratory systems. The obvious ones  are timeliness and accessibility. According to numerous studies it is cost-effective, and most of those were extremely limited studies that only assessed the actual cost’s of testing – not time saved or travel saved etc. In effect, they were completely distorted studies in terms of cost-effectiveness.

In Australia, where GP’s in remote areas often have to wait 3 days for an INR before adjusting a Warfarin dose, it seems illogical that we can’t give themPoC testing.

It’s detractors suggest GP’s might over-test (as if that doesn’t happen already). I would suggest that the very demands of organising the test in-house, while quick and easy, is still harder than ticking a box and would give GP’s and patients a better sense of the usefulness of their tests.

The last time PoC testing was evaluated by the government was apparently 1997. If they wait another 12 years before the next review I predict we’ll have the ability to buy kits off the internet for home use by then. Only because the government will pay for us to have a doctor do will patients not test themselves.

Yet again, the limitations of bureaucracy and the limitations of trying to evidence-base breakneck speed and complexity means a loss for consumers of health.

Will Patients Appreciate Big-Brother Pharmacists?

The Australian Pharmacy Guild has adapted software from the USA that allows pharmacists to track patient compliance with their medications. It is an attempt to get expand the professional role of pharmacists. And one drug company, Pfizer, has already teamed up with the guild to get pharmacists to coach patients at the point-of-dispensing if they seem to be missing doses of Lipitor.

It is a reality that compliance is an issue with many medications and therefore the software, named Mirixa, could be useful. But I wonder whether the creators considered what patients will think when a pharmacist leans over the counter and says, to their surprise, ‘you haven’t been taking your medication’! I’m sure, of course, they won’t do that because they will have read the guilds ‘motivational interviewing’ document for Mirixa.

It’s a principle in medicine that you never presume such knowledge, even is you think you have a good idea of compliance to a treatment prescribed. Patients hate doctors being paternalistic. So I find it very hard to see how patients will take to this approach unless they somehow ask to be signed up to the program (according to the consumer info this seems to be the case).

In fact, I wonder how this software fits in with our current privacy legislation? Perhaps someone can help me out? Mirixa does have a statement about privacy here.

Academics often exaggerate research – is this a surprise?

In Australia today, we hear a lot about healthcare companies, particularly those that develop pharmaceuticals. Little of what we hear is good news. While the ‘breakthroughs’ are attributed to researchers and hospitals, the companies that fund and support the work get all the attention when something goes wrong – or when people behave less than ethically.

Having worked in both the academic and commercial R+D sectors, my experience has been that academics are more likely to skew results. I believe this is the case for a whole variety of reasons, including a lack of good oversight, funding pressures, and publishing success being too closely linked to career progression.

Now there is some evidence to support my gut feeling.

A study in the Annals of Internal Medicine looks at press releases that academic medical centers send out about their research. They concluded that of 200 releases studied, 29 percent exaggerated their findings.

I’ve not read the study in detail, so won’t comment any further. It is reported in the WSJ Health blog.