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Sheila Devaney is Senior Medical Manager at Roche Diagnostics UK and Ireland. A health service transformation expert, Sheila helped lead several point-of-care respiratory testing pilots across the UK. She shares her insights on the potential impact of rapid respiratory testing for patients, clinicians and healthcare providers.
At the moment, for respiratory illnesses like influenza (flu), Respiratory Syncytial Virus (RSV) and Strep A, there are very few community diagnostic pathways. If a clinician seeks an accurate diagnosis, a sample has to go to a centralised laboratory, which in many cases either doesn’t happen, or can take a long time for a result. As a consequence, General practitioners (GPs) will often refer clinically vulnerable patients to secondary care.
To be most effective, treatments for respiratory illnesses like flu should be administered within 48 hours of symptoms appearing.
Bringing respiratory testing nearer to the patient in primary care means that a diagnosis can be delivered quickly. It can help empower clinicians to make appropriate treatment decisions within that crucial 48 hour window.
Rapid testing and accurate diagnosis means that clinicians can be more precise, rather than making an informed guess based on clinical symptoms alone. Patients with a confirmed clinical diagnosis can then receive more appropriate treatment at the earliest possible time, potentially improving outcomes.
At a system level, rapid respiratory diagnostics tests could potentially reduce the number of referrals to secondary care and help reduce inappropriate antibiotic prescribing.
Access to diagnostics in the community can be powerful. We know that getting a diagnosis quickly can help patients receive effective treatment, but this doesn’t always happen. We want to support the redesign of primary care respiratory patient pathways, bringing testing closer to patients.
Roche has been involved in several pilots to assess the impact of rapid respiratory testing for elderly and vulnerable patients. The purpose of the pilots is to help reduce the number of older people or clinically vulnerable people referred to hospital. The pilots also evaluated whether providing earlier diagnosis and treatment could potentially reduce patient deterioration and ultimately addmission to secondary care and even intensive care.
The pathways we have helped develop target patients in the community, catching them early, before their condition deteriorates. At a system level, rapid testing could help play a role in reducing the prevalence of flu, Strep A, RSV and COVID-19 circulating in communities.
Between December 2022 and March 2023, nine GP practices across Yorkshire and the North West implemented a community flu test-and-treat pilot. With the support of Roche they used rapid point-of-care testing (POCT). They wanted to assess if POCT in the community and digital reporting could help reduce pressure on the local healthcare system.
During the trial, 43,000 clinically at-risk patients were encouraged to take a flu test at one of the pilot sites if they developed symptoms. Data from the pilot was collected and analysed by an independent company. They estimated that rapid respiratory testing potentially helped to avoid 17 hospitalisations, one intensive care unit (ICU) admission and four deaths.
Respiratory testing in primary care can help support GPs to make appropriate prescribing decisions. It won't replace clinical expertise, but it can support it.
For example, during winter a patient with several existing underlying conditions may present with respiratory symptoms. The GP could be concerned about a virus, but the cause could also be bacterial.
In this case, a rapid respiratory test can provide diagnostic confidence, with the GP able to make a more informed decision whether to prescribe either an antibiotic or an antiviral, if required, depending on the cause of the condition.
Rapid respiratory testing – as part of a broader focus on common respiratory conditions – could have a positive impact on the health system and patient outcomes. It could help to free up appointments and reduce secondary care admissions. It potentially reduces the number of people attending hospital unnecessarily. This could also help reduce pressure on ambulances, which are often used to convey patients referred to secondary care from care homes.
Clinicians could use the tests to help them make the best treatment decisions, allowing patients to receive a more accurate diagnosis faster, which may help improve their outcomes. The potential impact could be beneficial not only for patients but also for the wider healthcare system.
