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Enhancing home care with point-of-care diagnostics

Easy-to-use diagnostic tests that deliver instant results have the potential to transform care in the home setting, reducing the need for patients to visit their GP surgery or hospital. For Specialist Practitioner Kirsty Bartlett, this technology presents an exciting research opportunity.

In 2022, Kirsty received an OAHP Research Development Award to fund the last stage of her Health and Sciences Open Award MSc at Oxford Brookes University – this included a module on Advanced Research Design. For her dissertation, Kirsty has looked at how diagnostic tools are used in primary care to reduce the overprescribing of antibiotics for non-bacterial infections.

“As an autonomous practitioner working with patients in their own home, I often find that I’m faced with treating an infection,” explains Kirsty, who originally trained as a nurse and works in the Urgent Community Response Team at Oxford Health NHS Foundation Trust. “Point-of-care CRP tests are available that can immediately tell us whether a patient has a viral or bacterial infection. But there’s been very little research involving non-medical prescribers using this sort of diagnostic test in the home setting. Most of the research I’ve looked at concerns GPs in a practice setting.”

Without knowing the cause of an infection, prescribers like Kirsty risk prescribing antibiotics for viral infections. As well being an ineffective way to treat a viral infection, prescribing the wrong drugs in this way can contribute to antimicrobial resistance, meaning antibiotics become less effective when they’re needed most.

Diagnostic tests that look for c-reactive proteins (CRP) in a patient’s blood can help to quickly determine whether they have a bacterial or viral infection. Armed with this information, non-medical prescribers would be able to prescribe the right treatment for their patients, reducing the need for further care.

Having now completed her dissertation and identified a gap in the research, Kirsty sees an opportunity for her team to trial these diagnostic tests in the home setting. This would provide much needed evidence that non-medical prescribers can make use of these tests, helping Kirsty to build the case for a quality improvement project so her team can deliver much more targeted treatments for their patients.

“As practitioners, we’re often involved in adopting new and improved ways of working, but we’re rarely called on to be part of developing these innovations,” she explains. “As a non-medical prescriber, I don’t want to be prescribing antibiotics unnecessarily for my patients, yet many patients with respiratory infections, which are most often caused by a virus, are given antibiotics. If we can reduce that by using better diagnostics, then that directly impacts the care that I provide – I want to be part of that change.”

Kirsty acknowledges that research isn’t for everyone, but there could be more opportunities for nurses and allied health professionals to lead their own research and quality improvement initiatives.

“Not everyone in my position is interested in research, but for those who are naturally inclined, then we have so much experience and insight to offer, given our role right at the heart of the community. Unfortunately, research opportunities aren’t always offered in a way that that makes them accessible for those on the fringes.

“Working in urgent community response, we’re all about stopping people going into hospital, and so we need to expand how we do that. For me, improving primary acute care with approaches grounded in research is naturally going to lead to improvements across the whole sector.”