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Our analysis suggests an important role in the future for multiplex devices that would enable health professionals to carry out their own tests at the point of care, greatly benefiting patients and speeding up their decision making.
- Dr Thomas Fanshawe, Senior Medical Statistician, University of Oxford

An analysis of clinical data shedding light on the frequency of blood test requests from primary care reveals the potential for diagnostic platforms that combine several commonly-requested tests onto ‘multiplex’ panels and could move blood testing from laboratory settings into the community.

Of more than 500 different blood tests analysed, the data indicated a variety of common community-requested test combinations, including tests for a general health check and to investigate anaemia, hormone levels, serum iron and vitamin levels, fatigue, and renal and liver function.

For the diagnosis of acute disease and the management of chronic conditions, the availability of and demand for point-of-care diagnostic tests in primary care has been gradually increasing, with many general practitioners keen to incorporate point-of-care tests directly into their practice to inform immediate decision making.

Multiplex technologies have the potential to combine different biochemical and haematological tests, which can be carried out from a single blood sample in a relatively short time, particularly where patients present with a large variety of conditions. Yet it remains unclear which tests should be included in these panels.

A research team from the University of Oxford’s Nuffield Department of Primary Care Health Sciences, UK and University of Leuven, Belgium analysed data from 11,763,473 laboratory blood tests requested by primary care practices in Oxfordshire for over 413,000 patients to spotlight the frequency and combination of tests requests in community settings.

Published in the Journal of Clinical Pathology, the study was funded by the National Institute for Health Research (NIHR) Community Healthcare MedTech and In Vitro Diagnostics Cooperative, an Oxford-based group hosted by Oxford Health NHS Foundation Trust which advances the development and evaluation of diagnostic tests to transform community healthcare.

Lead researcher, Dr Thomas Fanshawe, a Senior Medical Statistician in the University of Oxford, said: “There’s extremely high demand for laboratory blood tests from community settings in the UK, and our analysis suggests an important role in the future for multiplex devices that would enable health professionals to carry out their own tests at the point of care, greatly benefiting patients and speeding up their decision making. Replicating laboratory testing with panels of tests in combination is technologically feasible, although should such tests be developed we would need to understand more about how they’re used by practitioners to avoid situations where patients are tested unnecessarily.”

Dr Philip Turner, NIHR Community Healthcare MIC Manager, said “The NIHR Community Healthcare MIC instigated this project in response to questions from the IVD industry about what to include on multiplex point-of-care platforms. Combined with insights from our survey of general practitioners, this data-driven approach provides further evidence of where demand lies for diagnostic tests in community settings, although we would caution that the clinical utility of rapid point-of-care tests is contingent on a complex array of factors beyond demand.”

Read more

Fanshawe TR, Ordóñez-Mena JM, Turner PJ, et al. Frequencies and patterns of laboratory test requests from general practice: a service evaluation to inform point-of-care testing
Journal of Clinical Pathology
Published Online First: 18 September 2018. doi: 10.1136/jclinpath-2018-205242 

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