Unmet clinical needs for COVID-19 tests in UK health and social care settings

Abstract

There is an urgent requirement to identify which clinical settings are in most need of COVID-19 tests and the priority role(s) for tests in these settings to accelerate the development of tests fit for purpose in health and social care across the UK. This study sought to identify and prioritize unmet clinical needs for COVID-19 tests across different settings within the UK health and social care sector via an online survey of health and social care professionals and policymakers. Four hundred and forty-seven responses were received between 22nd May and 15th June 2020. Hospitals and care homes were recognized as the settings with the greatest unmet clinical need for COVID-19 diagnostics, despite reporting more access to laboratory molecular testing than other settings. Hospital staff identified a need for diagnostic tests for symptomatic workers and patients. In contrast, care home staff expressed an urgency for screening at the front door to protect high-risk residents and limit transmission. The length of time to test result was considered a widespread problem with current testing across all settings. Rapid tests for staff were regarded as an area of need across general practice and dental settings alongside tests to limit antibiotics use.

Fig 1. Settings with the greatest perceived unmet clinical need for COVID-19 tests, showing votes from respondents for their own setting (blue shading) and other settings (red shading).

Fig 2. The availability of COVID-19 tests in each setting as reported by respondents.

Primary and secondary dental settings were merged, in addition to care homes with and without nursing. The ‘Hospital-at-home’ (n = 3), hospices (n = 14) and ambulance setting (n = 9) were excluded due to the small number of overall respondents. Respondents were able to select multiple answers to this question. Plot key: ‘GP’ = ‘General Practice’; ‘POC’ = ‘Point of care’; ‘lab’ = ‘Laboratory.

Fig 3. Perceived consequences of no COVID-19 tests being available in each setting.

Primary and secondary dental settings were merged, in addition to care homes with and without nursing. The ‘Hospital-at-home’ (n = 3), hospice (n = 14) and ambulance setting (n = 9) were excluded due to the small number of overall respondents. A hierarchical cluster analysis indicates how similar/dissimilar the perceived consequences of no COVID-19 tests are between settings. The numbers of responses from individual settings for this particular question are displayed on the x axis (n = x). The histogram in the top left of the plot area shows the distribution of values, and provides a key to indicate the specific color shade of different values.

Fig 4. Perception of problems associated with COVID-19 testing practices in each setting.

Primary and secondary dental settings were merged, in addition to care homes with and without nursing. The ‘Hospital-at-home’, hospice and ambulance setting were excluded due to the small number of overall respondents (n<15). Respondents selected a single 'Yes', 'No' or 'Don't know' answer. The number of responses from individual settings for this particular question is displayed on the y axis (n = x).

Fig 5. Most important perceived problems associated with COVID-19 testing in each setting.

Primary and secondary dental settings were merged, in addition to care homes with and without nursing. The ‘Hospital-at-home’, hospice and ambulance setting (n<15) were excluded due to the small number of overall respondents. A hierarchical cluster analysis indicates how similar/dissimilar the perceived problems associated with COVID-19 testing are between settings. The numbers of responses from individual settings for this particular question are displayed on the x axis (n = x). The histogram in the top left of the plot area shows the distribution of values, and provides a key to indicate the specific color shade of different values.

Fig 6. Perceived consequences related to the problems associated with COVID-19 testing in each setting.

Primary and secondary dental settings were merged, in addition to care homes with and without nursing. The ‘Hospital-at-home’, hospice and ambulance setting (n<15) were excluded due to the small number of overall respondents. A hierarchical cluster analysis indicates how similar/dissimilar the perceived consequences related to the problems associated with COVID-19 testing are between settings. The numbers of responses from individual settings for this particular question are displayed on the x axis (n = x). The histogram in the top left of the plot area shows the distribution of values, and provides a key to indicate the specific color shade of different values.