Abstract

Point-of-care tests (POCTs) to diagnose sexually transmitted infections (STIs) have potential to positively impact patient management and patient perceptions of clinical services. Yet there remains a disconnect between development of new technologies and their implementation into clinical care. With the advent of new STI POCTs arriving to the global market, guidance for their successful adoption and implementation into clinical services is urgently needed. We conducted qualitative in-depth interviews with professionals prior to and post-implementation of a Chlamydia trachomatis/Neisseria gonorrhoeae POCT into clinical services in England to define key stakeholder roles and explore the process of POCT integration. Participants self-identified themselves as key stakeholders in the STI POCT adoption and/or implementation processes. Data consisted of interview transcripts, which were analysed thematically using NVIVO 11. Six sexual health services were included in the study; three of which have implemented POCTs. We conducted 40 total interviews: 31 prior to POCT implementation and 9 follow-up post-implementation. Post-implementation data showed that implementation plans required little or no change during service evaluation. Lead clinicians and managers self-identified as key stakeholders for the decision to purchase, while nurses self-identified as "change champions" for implementation. Many identified senior clinical staff as those most likely to introduce and drive change. However, participants stressed the importance of engaging all clinical staff in implementation. While the accuracy of the POCT, its positive impact on patient management and the ease of its integration within existing pathways were considered essential, costs of purchasing and utilising the technology were identified as central to the decision to purchase. Our study shows that key decision-makers for adoption and implementation require STI POCTs to have laboratory-comparable accuracy and be affordable for purchase and ongoing use. Further, successful integration of POCTs into sexual health services relies on supportive interpersonal relationships between all levels of staff.

Highlights

  • Point-of-care tests (POCTs) to enable to rapid and appropriate management of sexually transmitted infections (STIs) have potential to positively impact infection control, disease progression, and patient perceptions of clinical services [1–3]

  • Guidance for adoption of new diagnostics into clinical care are usually premised on evidence-based medicine (EBM), which is predicated on robust clinical research determining best clinical practice [6, 7]

  • Forty-eight invitations were sent to healthcare professionals (HCPs), commissioners and clinic managers; 31 (64.6%) participants took part in initial interviews

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Summary

Introduction

Point-of-care tests (POCTs) to enable to rapid and appropriate management of sexually transmitted infections (STIs) have potential to positively impact infection control, disease progression, and patient perceptions of clinical services [1–3]. Despite the potential advantages STI POCTs may bring, these do not necessarily lead to their adoption into clinical services. Guidance for adoption of new diagnostics into clinical care are usually premised on evidence-based medicine (EBM), which is predicated on robust clinical research determining best clinical practice [6, 7]. Social and contextual forces influencing new diagnostics’ adoption are poorly understood and receive relatively little formal attention compared to clinical efficacy data [10, 11]. Clinical practitioners have argued that their own clinical expertise—based on years of direct practice experience—is increasingly discounted in favour of EBM’s reliance on evidence from randomised controlled trials [9]. It has been suggested that key decision-makers consider social, structural and contextual factors as well as clinical trial data in their decision to implement new technologies [6, 12]

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