Point-of-care testing in care homes: a qualitative interview study with UK care home staff

Problem

Nearly half a million older people live in care homes in the UK. They require greater input from GPs, receive more antibiotics and have a higher admission rate compared to older people living in the community. In particular, episodes of acute functional decline without a clear cause in this population represent a diagnostic challenge to healthcare professionals and can result in antibiotic prescriptions or hospital admissions, although this may not always be the most appropriate management strategy. One solution may be to introduce more point-of-care tests (POCTs) into the care home setting. We aimed to understand how UK care home staff currently use and interpret POCTs and their perceived value of additional point-of-care testing in care homes.

Approach

This was a qualitative interview study with UK care home staff, including managers, nurses and carers. Participants were recruited through advertisements circulated via email, social media and word of mouth. Semi-structured interviews were conducted over the phone between January 2021 and April 2022. Thematic analysis was facilitated by NVivo software.

Findings

25 care home staff were interviewed, with a range of experience and a mix of nursing and non-nursing backgrounds. Most had experience of using POCTs including urine dipsticks and rapid lateral flow tests for COVID-19, and some had also been trained to test blood glucose. In general, they felt that fingerpick blood samples were easier to obtain than urine samples or nasal/throat swabs. Participants perceived that the advantages for care home residents of additional point-of-care testing in the care home included that the resident would have someone familiar doing the test, they could have a more rapid diagnosis when they were unwell, and they could potentially avoid a hospital attendance or admission. Some participants also talked about being able to more rapidly isolate residents in the case of an infectious outbreak. Participants felt that the advantages for care home staff included having more information when communicating to outside healthcare professionals about a resident of concern. However, they also highlighted the need for training to ensure any new procedure was done correctly and felt that any new test would have to be easy to read or interpret. Participants described the need for new tests to be cost-effective and to be appropriately funded, and how that any upskilling care home staff to perform POCTs should be recognised.

Consequences

Care home staff are receptive to expanding point-of-care testing within the care home. Their views on ideal test characteristics can be used when considering candidate tests to evaluate in this setting in the future.