Interview with Anni Matthes and Dr. Robby Markwart, Research associates, Institute of General Practice and Family Medicine at the University Hospital Jena
General practitioners (GP) regularly use on-site rapid tests because they find their application useful. However, frequent utilisation fails due to costs and remuneration regulations. These are the results of a study by InfectoGnostics researchers at the University Hospital Jena in the project "POCT-ambulant", in which 292 GPs in Thuringia, Bremen and Bavaria participated.
In an interview with MEDICA-tradefair.com, Anni Matthes, industrial and organisational psychologist and lead author of the study, and Dr. Robby Markwart, project leader and health services researcher, explain why this is often the case.
Anni Matthes
Why did you choose the topic of on-site rapid tests in general practice for your study?
Anni Matthes: At the InfectoGnostics research campus in Jena, research, industry and clinics are working closely together to develop novel solutions for the rapid, cost-effective and needs-based on-site diagnosis of infectious diseases. Although the 55,000 general practitioners in private practice represent by far the largest specialist group in outpatient care and are a relevant target group for rapid diagnostic tests, there are few studies in Germany on the use of such tests in general practice. However, well-founded knowledge is important so that the rapid tests are ultimately used in such a way that patients and doctors benefit.
Therefore, in the POCT-ambulant project (editor's note: POCT = Point-of-Care-Tests) at the Institute of General Medicine, we focus on studies on on-site diagnostics in general practitioner care. Our project is funded by the Federal Ministry of Education and Research.
Which rapid tests do general practitioners usually use?
Dr Robby Markwart: Our study shows that six different rapid tests are currently used by more than 50 percent of general practitioners: Urine strip test, glucose in urine and blood, SARS-CoV-2 rapid tests, microalbumin in urine, troponin I/T and Quick value.
Why these tests and no others?
Dr. Robby Markwart
Markwart: Why certain rapid tests are used depends on many factors. One important factor is remuneration: not all rapid tests are adequately reimbursed, so the use of these tests represents a financial loss for the practice. Furthermore, not all doctors trust the accuracy of the test. Some rapid tests are perceived as not sensitive enough. They often show a negative result, even though the person concerned is ill.
The frequency of use also determines the purchase. For example, rapid tests for the detection of sepsis make little sense in the general practitioner's office, whereas sepsis is a fairly frequent complication in intensive care units, so rapid sepsis diagnostics are important there.
Another factor is the added value compared to standard diagnostic procedures. Flu infections, for example, can be well assessed by history and physical examinations. A rapid test is not necessary in every case. On the other hand, certain rapid tests can help to differentiate between viral and bacterial infections and to use antibiotics effectively.
How do you classify the results of your study?
Markwart: Our work is the first study in Germany to scientifically assess the use of rapid tests and the associated general practitioner perspectives, opportunities, and limitations. Our results show that general practitioners in Germany consider rapid tests helpful because they enable immediate clinical decisions as well as increase the perceived certainty in their decision-making. However, there are several test-related barriers, such as test accuracy and contextual factors and remuneration or perceived clinical utility that hinder implementation.
For the InfectoGnostics study, research, industry and clinic worked closely together.
How could the use of rapid tests be increased?
Matthes: For good medical care, it is important that rapid tests, like other diagnostic or therapeutic procedures, are used and interpreted in a targeted manner in the right clinical situation. The goal is therefore to create conditions that promote this evidence-based use of rapid tests. Here, it is important that we generate scientific findings that are relevant to general practices. If these findings are well communicated and incorporated into medical guidelines, education, and training, this will promote the correct use of rapid tests. Furthermore, it is important that rapid tests are developed that meet the requirements and needs of general practices with ease of use and sufficient accuracy so that doctors and patients can trust the results. The costs must also be in relation to the clinical benefit.
What "homework" do health insurance companies, associations of statutory health insurance physicians, developers, and medical professionals still have to do for this?
Matthes: In recent years, few new billing options for new rapid tests have been created for physicians in private practice, or existing reimbursements have been adjusted. That is why it would make sense for the parties involved, namely health insurance funds and associations of SHI-accredited physicians, to discuss this. The benefits of the rapid tests should be taken into account when deciding on remuneration. For this reason, scientific projects to investigate the potential benefits should be increasingly promoted. In addition to funding programmes on the part of health insurance funds and associations of statutory health insurance physicians, we also see the Federal Ministry of Health and the Federal Ministry of Education and Research as having an obligation in this regard.
In addition, it is important that the general practitioners' association deals with new rapid test solutions and their benefits for patient care. To this end, clinical guidelines on rapid tests in the doctor's practice must be drawn up that provide evidence-based recommendations for the use of the tests. In addition, the use of diagnostic tests should already be anchored in medical studies, medical training and further education.
On the part of the companies and developers, it is necessary to involve the users at an early stage and to know the framework conditions of outpatient care in order to incorporate requirements from practice in the development of rapid tests.
