| Summary: | <p>Point of care testing (POCT) technologies permit the rapid measurement of blood medication levels and of haematological parameters. This thesis aimed to assess the extent to which POCT can be used to monitor the levels of antipsychotic medications that are used to treat people with schizophrenia, and white blood cell and neutrophil counts in people who are being treated with the antipsychotic medication clozapine. I compared the utility of POCT devices with conventional venous blood methods and assessed the acceptability of these technologies in clinical practice. In a study involving 309 patients with schizophrenia, I found that the MyCare™ Insite POCT device for the measurement of clozapine concentrations from 20µL of capillary blood from a finger prick sample, gave comparable accuracy when compared to the standard laboratory method using venous blood. I then compared the performance of the HemoCue® WBC DIFF System, OLO®, and HemoScreen® POCT methods for measuring white blood cell and neutrophil counts with the standard laboratory method using venous blood. Each comparison involved >200 patients with schizophrenia. The Hemoscreen device gave the most accurate results compared to the venous standard laboratory method. Finally, I compared the performance of the MyCare Insite POCT device for the measurement of aripiprazole concentrations using capillary blood samples with a lab-based assay that used venous blood samples in 101 patients with schizophrenia. The POCT aripiprazole assay provided a comparable level of accuracy to the conventional assay.</p>
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<p>I assessed the acceptability and feasibility of POCT in 106 patients with schizophrenia and 10 clinicians, using a brief questionnaire. 98% of patients found a capillary point-of-care approach acceptable, and 85% preferred it to the conventional venous blood procedure. 78% of patients felt it was useful to have access to the result at the point of care, and 90% felt that POCT improved their care. Clinical staff also preferred the POCT approach.</p>
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<p>The results suggest that POCT for antipsychotic medications and haematology can be as accurate as conventional lab-based assays, and have the advantage of being able to provide results at the time of testing, and being more acceptable to both patients and clinicians.</p>
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