BMJ 1999;319:824-827 ( 25 September )

General Practice

Systematic review of near patient test evaluations in primary care

Brendan C Delaney, senior lecturer, ^a Chris J Hyde, director, aggressive research intelligence facility, ^b Richard J McManus, clinical research fellow, ^a Sue Wilson, senior research fellow, ^a David A Fitzmaurice, senior lecturer, ^a Sue Jowett, research associate, ^a Ros Tobias, research fellow, ^a Gary H Thorpe, director, ^c F D Richard Hobbs, professor. ^a

^a Department of Primary Care and General Practice, University of Birmingham, Birmingham B15 2TT, ^b Department of Public Health and Epidemiology, University of Birmingham, ^c Wolfson Applied Technology Laboratory, University of Birmingham

Correspondence to: F D R Hobbs f.d.r.hobbs{at}bham.ac.uk

Objective: To identify and qualitatively synthesise the findings from all studies that have examined the performance and effect of near patient tests in the primary care setting.
Design: Systematic review of published and unpublished research 1986-99.
Main outcome measures: Test performance characteristics, measures of effect on clinical practice or patient outcome.
Results: 101 relevant publications were identified. The general quality of these papers was low, and consequently only 32 papers were assessed in detail. Although these papers gave some indication of the value of near patient testing in areas such as anticoagulation monitoring and group A  haemolytic streptococcus testing, the research raised many more questions than it answered. Almost no reports were found of unbiased assessment of the effect of near patient tests in primary care on patient outcomes, organisational outcomes, or cost.
Conclusions: Available research provides little evidence to guide the expansion of use of near patient testing in primary care. Further research is needed in areas of clinical practice where near patient tests might be most beneficial.

Key messages Near patient testing is a rapidly evolving technology with potential to improve the quality of diagnosis and management in primary care The performance of most tests has not been adequately evaluated in primary care No robust studies of the effectiveness of near patient tests in improving patient outcomes have been conducted High quality evaluations of the performance and effectiveness of near patient tests in defined clinical situations are needed before further expansion

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