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Cost consequences of point-of-care troponin T testing in a Swedish primary health care setting
Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in East Östergötland, Primary Health Care in Norrköping.
Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care.
Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.ORCID iD: 0000-0002-9375-5087
County Hospital Ryhov, Sweden.
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2014 (English)In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 32, no 4, 241-247 p.Article in journal (Refereed) Published
Abstract [en]

Objective. To evaluate the safety and cost-effectiveness of point-of-care troponin T testing (POCT-TnT) for the management of patients with chest pain in primary care. Design. Prospective observational study with follow-up. Setting. Three primary health care (PHC) centres using POCT-TnT and four PHC centres not using POCT-TnT in south-east Sweden. Patients. All patients greater than= 35 years of age, contacting one of the PHC centres for chest pain, dyspnoea on exertion, unexplained weakness and/or fatigue, with no other probable cause than cardiac, were included. Symptoms must have commenced or worsened during the previous seven days. Main outcome measures. Emergency referral rates, diagnoses of acute myocardial infarction (AMI) or unstable angina (UA), and costs were collected for 30 days after the patient sought care at the PHC centre. Results. A total of 196 patients with chest pain were included: 128 in PHC centres with POCT-TnT and 68 in PHC centres without POCT-TnT. Fewer patients from the PHC centres with POCT-TnT (n = 32, 25%) were emergently referred to hospital than from centres without POCT-TnT (n = 29, 43%; p = 0.011). Eight patients (6.2%) from PHC centres with POCT-TnT were diagnosed with AMI or UA compared with six patients (8.8%) from centres without POCT-TnT (p = 0.565). Two patients with AMI or UA were classified as missed cases from PHC centres with POCT-TnT and there were no missed cases from PHC centres without POCT-TnT. SKr290 000 was saved per missed case of AMI or UA. Conclusion. The use of POCT-TnT in primary care may be cost saving but at the expense of missed cases.

Place, publisher, year, edition, pages
Informa Healthcare , 2014. Vol. 32, no 4, 241-247 p.
Keyword [en]
Acute myocardial infarction; general practice; point-of-care testing; primary care; Sweden; troponin T; cost
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Basic Medicine Clinical Medicine
Identifiers
URN: urn:nbn:se:liu:diva-113177DOI: 10.3109/02813432.2014.984901ISI: 000346108700014PubMedID: 25434410OAI: oai:DiVA.org:liu-113177DiVA: diva2:780039
Note

Funding Agencies|County Council of Ostergotland

Available from: 2015-01-13 Created: 2015-01-12 Last updated: 2017-12-05

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Nilsson, StaffanAndersson, AgnetaJanzon, MagnusLevin, Lars-Åke

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Division of Community MedicineFaculty of Health SciencesPrimary Health Care in NorrköpingResearch & Development Unit in Local Health CareDivision of Cardiovascular MedicineDepartment of Cardiology in LinköpingDivision of Health Care Analysis
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