The prevalence of non-communicable diseases (NCDs) is increasing worldwide. This has a significant impact on the global disease burden and healthcare economy. The impact of the major NCDs (diabetes, cardiovascular diseases, cancer, chronic respiratory diseases and mental disorders) account for an estimated 86% of the deaths and 77% of the disease burden in Europe . The increasing prevalence of NCDs is, in part, attributed to an increasingly ageing population, but also due to an increase in the prevalence of risk-factors common amongst most NCDs such as physical inactivity, refined diets and overweight/obesity. In 2011 the United Nations General Assembly received the commitment from world leaders to take measures to tackle NCDs. Subsequently there have been several policy interventions to support this agenda. Notably the inclusion of NCDs, with measurable targets and indicators, under the third of the “Sustainable Development Goals” .
The incidence of NCDs is a key example of the health inequalities that pervade modern society, as lower socio-economic groups struggle to access preventative services due to cost and geographic location. In addition to the substantial health burden, NCDs also contribute a significant economic burden. A report published by the World Economic Forum and the Harvard School of Public Health in 2011, predicted that over the next 20 years, NCDs will cost more than 30 trillion US$, which is the equivalent of 48% of global GDP in 2010. The report goes on to state that lost output from the five most prevalent NCDs over the period 2011–2030 is estimated at nearly 47 trillion US$ . Furthermore, in Europe in 2015, public expenditure on health was 7.8% of GDP in the EU as a whole and in 2013, premature deaths due to major NCDs cost EU economies around 0.8% of GDP. Moreover, non-health costs of NCD in the EU such as productivity losses due to mortality and morbidity associated with CVD cost €54 billion in 2015 alone .
Given the growing NCD burden and the fact that allied health professionals (AHPs) have access to large proportions of the population who may not engage with other healthcare services , AHPs are ideally placed to assist with the early identification of NCDs in non-traditional community settings. Dental care professionals (DCPs) and pharmacists are trained and skilled in risk-assessment and routinely deliver preventative advice, such as smoking cessation, exercise and advice on healthy nutrition. Risk assessment for specific NCDs, followed by early case detection is a natural extension of their current roles. Importantly, stakeholder opinion for AHPs undertaking risk assessments for certain NCDs is extremely positive [5, 6]. Public support for screening for medical conditions in both dental and pharmacy settings is strong, with particular support for risk-targeted early case detection in type 2 diabetes (T2DM) and hypertension . Patients as well as pharmacists, physicians and dentists also support public opinion for such novel care pathways .
Point of care testing (POCT), is a testing method that does not require samples to be sent to an accredited laboratory, and instead is undertaken near the patient, often chairside or bedside and provides results in a short timeframe . POCT can be of benefit when an immediate result is required or when access to a laboratory is not feasible, practical or readily available. This may be the case in community-based healthcare settings such as primary care dental practices and community pharmacy settings.
The National Institute for Health and Care Excellence (NICE) in England currently recommends that AHPs risk-assess for T2DM . Data from the US and Europe suggest that screening for T2DM in a dental setting is effective for identifying those at high risk and those who already unknowingly have the condition [6, 10,11,12,13,14,15]. Whilst NICE guidance currently suggests using a validated risk assessment questionnaire, the literature suggests POCT devices are often used in conjunction or instead of these validated questionnaires [6, 10, 14,15,16,17].
UK government policies actively encourage dental care professionals (DCPs) to deliver general health promotion [18, 19]. It has been suggested that highly skilled primary healthcare professionals, such as DCPs, may develop new roles and integrate care provision more seamlessly with GPs to create effective multi-disciplinary teams and care-pathways to benefit patients. The provision of a wider range of services by AHPs in collaboration with GPs, such as early detection of systemic NCDs, provides greater access to care for vulnerable groups and helps to address the highly prevalent healthcare inequalities that have been highlighted by the SARS-COV-2 pandemic [20, 21]. This aligns closely with the UK “Making Every Contact Count” agenda to improve general health and wellbeing . Similarly, UK policy and pharmacists' professional organisations have stressed the potential of community pharmacists to extend their roles in patient care services to include screening for NCDs. This has been emphasised in policy papers calling for a wider use of community pharmacists in primary patient care [20, 23, 24]. In the UK, POCT is considered an important development area for the future of pharmacy, it is supported by the Royal Pharmaceutical Society and the National Pharmaceutical Association. Several pilot initiatives in pharmacies across the UK have taken place, including testing for T2DM, coronary heart disease and cholesterol .
This study forms part of a broader body of work to determine: the acceptability to stakeholders (patients, the public, and healthcare professionals) of utilising AHPs to undertake risk-targeted early case detection of potentially high-risk individuals for specific non-communicable diseases (NCDs) , patient acceptability of undertaking risk-targeted early case detection for NCDs within a general dental practice and community pharmacy setting [6, 26], and the concordance of point of care testing (POCT) devices against laboratory methods.
Controversies surrounding the reliability and accuracy of POCT devices has traditionally provided a barrier to their uptake [27, 28], as has the variability in precision of the large number of available devices . Venous blood analysis using laboratory-based methods remains the reference standard. However, the improved quality and precision of POCT devices for capillary blood sampling has led to NICE and other national bodies recommending their use for diagnosis in some cases [27, 30,31,32,33]. Despite this recommendation, the preference for conventional diagnostic methods by a physician for formal diagnosis and appropriate provision of treatment plans remain. Given that venous sample collection in many community settings is challenging it is important that POCT devices if utilised demonstrate high concordance with current standard reference-assays.
Here we report a two-staged exploratory study. Stage one aimed to measure the agreement between POCT devices with a central laboratory method for: HbA1C (diabetes), creatinine/e-GFR (chronic kidney disease) and total vitamin D. The devices calibrated were the Nova StatSensor (creatinine/estimated Glomerular-Filtration-Rate [eGFR]), Siemens DCA Vantage (HbA1c), and CityAssays (vitamin D capillary blood-spot tests). This stage also aimed to gauge the opinions of the participants regarding acceptability of the method of blood collection. Stage two comprised a study within one dental and one community pharmacy in the West-Midlands, UK, to determine patient acceptability of risk-assessment for NCDs in these settings, utilising validated risk-questionnaires followed by the POCT devices .