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Does point-of-care testing lead to the same or better adherence to medication? A randomised controlled trial: the PoCT in General Practice Trial

Angela Gialamas, Lisa N Yelland, Philip Ryan, Kristyn Willson, Caroline O Laurence, Tanya K Bubner, Philip Tideman and Justin J Beilby
Med J Aust 2009; 191 (9): 487-491.

Summary

Objective: To compare the clinical effectiveness of point-of-care testing (PoCT) with that of pathology laboratory testing, as measured by patients’ adherence to medication.

Design: Multicentre, cluster randomised controlled trial using non-inferiority analysis. Medication adherence was assessed twice (in April 2006 and January 2007) by a self-administered questionnaire using the five-item Medication Adherence Report Scale (MARS-5).

Setting: 53 Australian general practices in urban, rural and remote areas across three Australian states, September 2005 to February 2007.

Participants: 4968 patients with established type 1 or type 2 diabetes, established hyperlipidaemia, or requiring anticoagulant therapy were recruited to the study. Of these, 4381 were included in the analysis (2585 in the intervention group and 1796 in the control group).

Intervention: The intervention group (3010 patients in 30 practices) had blood and urine samples tested using PoCT devices within their general practices. The control group (1958 patients in 23 practices) had samples tested by their usual pathology laboratories.

Main outcome measures: The proportion of questionnaire responses indicating medication adherence overall and by condition.

Results: PoCT was non-inferior to pathology laboratory testing in relation to the proportion of questionnaire responses indicating medication adherence (39.3% v 37.0%) (difference, 2.3% [90% CL, – 0.1%, 4.6%]; P < 0.001). Non-inferiority could also be concluded separately for patients with diabetes (38.5% v 37.3%) (difference, 1.2% [90% CL, – 2.5%, 5.0%]; P = 0.01); hyperlipidaemia (38.3% v 37.3%) (difference, 1.0% [90% CL, – 1.5%, 3.5%]; P < 0.001) and for patients requiring anticoagulant therapy (44.5% v 41.4%) (difference, 3.1% [90% CL, – 2.1%, 8.3%]; P = 0.01).

Conclusions: Having access to immediate test results through PoCT is associated with the same or better medication adherence compared with having test results provided by a pathology laboratory. PoCT used in general practice can provide general practitioners and patients with timely and complete clinical information, facilitating important self-management behaviours such as medication adherence.

Trial registration: Australian Clinical Trials Registry ACTRN 12605000272695.

  • Angela Gialamas1
  • Lisa N Yelland2
  • Philip Ryan2
  • Kristyn Willson2
  • Caroline O Laurence1
  • Tanya K Bubner1
  • Philip Tideman3
  • Justin J Beilby4

  • 1 Discipline of General Practice, University of Adelaide, Adelaide, SA.
  • 2 Discipline of Public Health, University of Adelaide, Adelaide, SA.
  • 3 Integrated Cardiovascular Clinical Network SA, Flinders Medical Centre, Adelaide, SA.
  • 4 Faculty of Health Sciences, University of Adelaide, Adelaide, SA.


Acknowledgements: 

The PoCT in General Practice Trial was funded by the Australian Department of Health and Ageing through the Pathology Section, Diagnostics Services Branch. The trial management committee members are Justin Beilby, Jan Gill, Briony Glastonbury, Caroline Laurence, Roger Killeen, Pamela McKittrick, Mark Shephard, Andrew St John, David Thomas, Phil Tideman, Rosy Tirimacco and Paul Worley.

Competing interests:

None identified.

  • 1. World Health Organization. Diet, nutrition and the prevention of chronic diseases. Geneva: WHO, 2003.
  • 2. Cramer J. A systematic review of adherence with medications for diabetes. Diabetes Care 2004; 27: 1218-1224.
  • 3. Huser M, Evans T, Berger V. Medication adherence trends with statins. Adv Ther 2005; 22: 163-171.
  • 4. Senior V, Marteau T, Weinman J; Genetic Risk Assessment for FH Trial (GRAFT) Study Group. Self-reported adherence to cholesterol-lowering medication in patients with familial hypercholesterolaemia: the role of illness perceptions. Cardiovasc Drugs Ther 2004; 18: 475-481.
  • 5. Jackevicius C, Mamdani M, Tu J. Adherence with statin therapy in elderly patients with and without acute coronary syndromes. JAMA 2002; 288: 462-467.
  • 6. Sabaté E. Adherence to long-term therapies: evidence for action. Geneva: World Health Organization, 2003.
  • 7. Horne R, Weinman J, Barber N, et al. Concordance, adherence and compliance in medicine taking. London: National Co-ordinating Centre for NHS Service Delivery and Organisation Research and Development, 2005. http://www.sdo. nihr.ac.uk/files/project/76-final-report.pdf (accessed Sep 2009).
  • 8. Tabrizi J, Wilson A, Coyne E, O’Rourke P. Clients’ perspective on service quality for type 2 diabetes in Australia. Aust N Z J Public Health 2007; 31: 511-515.
  • 9. Kaplan S, Greenfield S, Ware JE Jr. Assessing the effects of physician–patient interactions on the outcomes of chronic disease. Med Care 1989; 27 (3 Suppl): S110-S127.
  • 10. Delaney B, Hyde C, McManus R, et al. Systematic review of near patient test evaluations in primary care. BMJ 1999; 319: 824-827.
  • 11. Laurence C, Gialamas A, Yelland L, et al. A pragmatic cluster randomised controlled trial to evaluate the safety, clinical effectiveness, cost effectiveness and satisfaction with point of care testing in a general practice setting — rationale, design and baseline characteristics. Trials 2008; 9: 50.
  • 12. Horne R, Weinman J. Patients’ beliefs about prescribed medicines and their role in adherence to treatment in chronic physical illness. J Psychosom Res 1999; 47: 555-567.
  • 13. Farmer A, Kinmonth AL, Sutton S. Measuring beliefs about taking hypoglycaemic medication among people with Type 2 diabetes. Diabet Med 2006; 23: 265-270.
  • 14. George J, Kong D, Thoman R, Stewart K. Factors associated with medication nonadherence in patients with COPD. Chest 2005; 128: 3198-3204.
  • 15. Haynes R, McDonald H, Garg A. Helping patients follow prescribed treatment: clinical applications. JAMA 2002; 288: 2880-2883.
  • 16. Stephenson B, Rowe B, Haynes R, et al. The rational clinical examination: is this patient taking the treatment as prescribed? JAMA 1993; 269: 2779-2781.
  • 17. Piaggio G, Elbourne D, Altman D, et al; CONSORT Group. Reporting of noninferiority and equivalence randomized trials: an extension of the CONSORT statement. JAMA 2006; 295: 1152-1160.
  • 18. Kripalani S, Yao X, Haynes RB. Interventions to enhance medication adherence in chronic medical conditions: a systematic review. Arch Intern Med 2007; 167: 540-550.
  • 19. Bubner TK, Laurence CO, Gialamas A, et al. Effectiveness of point-of-care testing for therapeutic control of chronic conditions: results from the PoCT in General Practice Trial. Med J Aust 2009; 190: 624-626. <MJA full text>
  • 20. Laurence C, Gialamas A, Bubner T, et al. Patient satisfaction with point of care testing in general practice. Br J Gen Pract 2009. In press.
  • 21. Brown J, Harris S, Webster-Bogaert S, Porter S. Point-of-care testing in diabetes management: what role does it play? Diabetes Spectr 2004; 17: 244-248.
  • 22. Shephard M. Cultural and clinical effectiveness of the “QAAMS” point-of-care testing model for diabetes management in Australian Aboriginal medical services. Clin Biochem Rev 2006; 27: 161-170.
  • 23. Kerse N, Buetow S, Mainous A, et al. Physician–patient relationship and medication compliance: a primary care investigation. Ann Fam Med 2004; 2: 455-461.
  • 24. Blakeman T, Macdonald W, Bower P, et al. A qualitative study of GPs’ attitudes to self-management of chronic disease. Br J Gen Pract 2006; 56: 407-414.
  • 25. Zailinawati A, Ng C, Nik-Sherina H. Why do patients with chronic illness fail to keep their appointments? A telephone interview. Asia Pac J Public Health 2006; 18: 10-15.
  • 26. Farmer K. Methods for measuring and monitoring medication regimen adherence in clinical trials and clinical practice. Clin Ther 1999; 21: 1074-1090.

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