A Human Factors approach to COVID-19 testing process
Cross-cutting studies by the NIHR London In Vitro Diagnostics Co-operative (LIVD), in collaboration with the NIHR Newcastle In Vitro Diagnostics Co-operative (NIVD) and the NIHR Community Healthcare MedTech and In-vitro Diagnostics Co-operative (CH IVD) (under the auspices of the NIHR CONDOR network), have evaluated current diagnostic procedures for COVID-19 in primary care, prehospital care (ambulance), secondary care and care homes.
Graziadio, S., Urwin, S.G., Cocco, P., Micocci, M., Winter, A., Yang, Y., Price, D.A., Messenger, M., Allen, A.J., Shinkins, B. and CONDOR Steering group, 2020. Unmet clinical needs for COVID-19 tests in UK health and social care settings. PloS one, 15(11), p.e0242125.
Patrick Kierkegaard, Anna McLister, Peter Buckle; Rapid point-of-care testing for COVID-19: quality of supportive information for lateral flow serology assays. BMJ Open. http://dx.doi.org/10.1136/bmjopen-2020-047163
COVID-19 testing in care homes
We have conducted a series of exploratory studies to scope usability and integration pathway of three point-of-care-tests (POC) as opposed to medical laboratory testing – in care homes. These devices are marketed as lab equipment and not designed to be used in a community setting and by non-qualified personnel. Emergency authorisations have made available these technologies in various clinical and non-clinical settings, with an urgent identification of biosafety and usability issues. Through a combination of expert reviews, remote usability observations and semi-structured interviews, we have highlighted potential errors in use, biosafety issues, the readiness of the care homes to test for COVID-19, use cases and testing strategies. In combination with agreement studies with laboratory PCR (polymerase chain reaction), we have provided evidence to inform effective procurement decisions and safeguard measures for patients and staff members. The adoption of these technologies has the benefit of reducing waiting time to get test results and a consequent more efficient use of cohorts’ areas, but the deployment of diagnostic devices in care homes demands specific training and qualified personnel, an efficient and reliable algorithm, and measure of risk management.
Micocci M., Gordon A.L., Allen A.J., Hicks T., Kierkegaard P., McLister A., Walne S., Hayward G., Buckle P., on behalf of the CONDOR study team, 2021. COVID-19 testing in English care homes and implications for staff and residents. Age and Ageing, 50(3), Pages 668–672, https://doi.org/10.1093/ageing/afab015
Kierkegaard, P., Micocci, M., McLister, A., Tulloch, J., Parvulescu, P., Gordon, A. and Buckle, P., 2021. Implementing Lateral Flow Devices in Long-Term Care Facilities: Experiences from the Liverpool COVID-19 Community Testing Pilot in Care Homes-A Qualitative Study. Available at SSRN 3825945.
Tulloch, J., Micocci, M., Buckle, P., Lawrenson, K., Kierkegaard, P., McLister, A., Gordon, A., García-Fiñana, M., Peddie, S., Ashton, M. and Buchan, I., 2021. Enhanced Lateral Flow Testing Strategies in Care Homes Are Associated with Poor Adherence and Were Insufficient to Prevent COVID-19 Outbreaks: Results from a Mixed-Methods Implementation Study. Available at SSRN 3822257.
Micocci, M., Buckle, P., Hayward, G., Allen, A.J., Davies, K., Kierkegaard, P., Spilsbury, K., Thompson, C., Astle, A., Heath, R. and Sharpe, C., 2021. Point of Care Testing using rapid automated Antigen Testing for SARS-COV-2 in Care Homes–an exploratory safety, usability and diagnostic agreement evaluation. medRxiv. https://doi.org/10.1101/2021.04.22.21255948
COVID-19 testing in primary care
In collaboration with the NIVD and CH IVD, LIVD researchers led a study between September and November 2020 that involved examining the barriers/enablers of implementing SARS-CoV-2 POC testing into the primary care setting. LIVD researchers conducted interviews with 22 clinicians from 21 general practices across three regions in England to examine general practitioners (GPs) knowledge and attitudes about implementing SARS-CoV-2 POC tests into the primary care setting. Our interviews illuminate the impact that SARS-CoV-2 POC tests might have on general practices, assessed the feasibility of introducing them into general practice, examined the potential impact on infection control in primary care, and identified facilitators and barriers to adoption including attitudes toward SARS-CoV-2 POC tests. GPs had significant reservations based on the limited information available, an overwhelming workload, and the potential for increased occupational exposure to SARS-CoV-2. GPs were more likely to adopt POC tests if conducting testing added value to care management, if additional resources were made available to offset the increased workload, and evidence was available to assure them that POC tests would reduce occupational and patient exposure. The implications of our results indicated that it may be necessary to incentivise POC testing by providing additional government funding to create the necessary infrastructure to limit the anticipated additional workload practices would face. Overall, our findings provided important information that can inform policy development concerning planning and implementation of testing programmes for COVID-19 and future pandemics.
Kierkegaard, P., Hicks, T., Yang, Y., Lee, J., Hayward, G., Turner, P.J., Allen, A.J. and Nicholson, B.D., 2021. Primary care and point-of-care testing during a pandemic: Clinician’s perspectives on integrating rapid testing for COVID-19 into the primary care pathway. medRxiv.
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