Deon Lingervelder
1* 
, Hendrik Koffijberg
1 , Jon D. Emery
2, Paul Fennessy
3, Christopher P. Price
4, Harm van Marwijk
5, Torunn B. Eide
6, Sverre Sandberg
7,8,9, Jochen W.L. Cals
10, Joke T.M. Derksen
11, Ron Kusters
1,12, Maarten J. IJzerman
1,13 1 Health Technology and Services Research Department, Technical Medical Centre, University of Twente, Enschede, The Netherlands.
2 Department of General Practice and Centre for Cancer Research, University of Melbourne, Melbourne, VIC, Australia.
3 Department of Health & Human Services, State Government of Victoria, Melbourne, VIC, Australia.
4 Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
5 Department of Primary Care and Public Health, Brighton and Sussex Medical School, University of Sussex, Falmer, UK.
6 Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway.
7 The Norwegian Organisation for Quality Improvement of Laboratory Examinations (NOKLUS), Haraldsplass Deaconess Hospital, Bergen, Norway.
8 Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
9 Norwegian Porphyria Centre, Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway.
10 Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands.
11 Sector Zorg, Zorginstituut Nederland, Diemen, The Netherlands.
12 Laboratory for Clinical Chemistry and Haematology, Jeroen Bosch Hospital, ‘s-Hertogenbosch, The Netherlands.
13 Cancer Health Services Research, School of Population and Global Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia.
Abstract
Background: In some countries, such as the Netherlands and Norway, point-of-care testing (POCT) is more widely implemented in general practice compared to countries such as England and Australia. To comprehend what is necessary to realize the benefits of POCT, regarding its integration in primary care, it would be beneficial to have an overview of the structure of healthcare operations and the transactions between stakeholders (also referred to as value networks). The aim of this paper is to identify the current value networks in place applying to POCT implementation at general practices in England, Australia, Norway and the Netherlands and to compare these networks in terms of seven previously published factors that support the successful implementation, sustainability and scale-up of innovations.
Methods: The value networks were described based on formal guidelines and standards published by the respective governments, organizational bodies and affiliates. The value network of each country was validated by at least two relevant stakeholders from the respective country.
Results: The analysis revealed that the biggest challenge for countries with low POCT uptake was the lack of effective communication between the several organizations involved with POCT as well as the high workload for general practitioners (GPs) aiming to implement POCT. It is observed that countries with a single national authority responsible for POCT have a better uptake as they can govern the task of POCT roll-out and management and reduce the workload for GPs by assisting with set-up, quality control, training and support.
Conclusion: Setting up a single national authority may be an effective step towards realizing the full benefits of POCT. Although it is possible for day-to-day operations to fall under the responsibility of the GP, this is only feasible if support and guidance are readily available to ensure that the workload associated with POCT is limited and as low as possible.