Background In a tertiary respiratory centre, large cohorts of patients are managed in the outpatient setting and require monitoring of inflammatory or disease activity markers and organ toxicity from medications. This either requires utilisation of primary care services for phlebotomy and subsequent physician review of results or frequent visits to tertiary centres. Although remote monitoring, such as telemedicine and wearable technology (e.g. remote spirometry), is being increasingly utilised in the outpatient setting, there is little data analysing the possibility of remote blood test monitoring.
Purpose To identify the potential healthcare utilisation of remote capillary blood testing in a tertiary level chronic lung disease cohort.
Methods A retrospective analysis of blood testing in outpatient cystic fibrosis clinics, assessing frequency, indication and delayed impact upon clinical plans. This was followed by a prospective single centre validation study of finger prick capillary blood testing using a novel capillary blood collection system compared to local standard venesection. Results were analysed using paired T test and Bland-Altman statistical analysis.
Results 18 outpatient clinics with 181 patients were retrospectively analysed. 63 patients underwent blood testing, of which 41 (65%) patients’ blood tests were predictable prior to the clinic visit. 16% of patients who underwent blood tests were consequently contacted after the clinic due to actions required from results.
A number of tests (including CPR, IgE, ALT and HbA1c) showed no significant differences (paired T test p≤0.05) between the capillary sample and control (standard venesection), and good method comparison through Bland Altman analysis, suggesting accuracy of remote finger prick monitoring. (see Figure 1) Other tests, including FBC and renal function, showed significant statistical differences between the capillary and venous samples.
Following validation it was evident that 23 patients (56%) who underwent venesection for predictable reasons could have provided accurate blood samples by exclusively using remote finger prick monitoring rather than standard venesection.
Conclusions Remote capillary blood testing could potentially be utilised in over half of patients requiring blood monitoring in the outpatient setting to either prevent a hospital visit or be provided in advance of clinic visits to provide contemporaneous clinical data to aid shared management planning.
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