Table 2.
Diagnostic test utilization, POC test availability, and referral sites for patients with infectious diseases.
| Survey Questions | Level 2 Provincial Hospital N = 1 | Level 3 District Hospitals N = 7 (Response Frequency by Sites Surveyed) |
Level 4 Community Health Centers N = 7 (Response Frequency by Sites Surveyed) |
|---|---|---|---|
| Diagnostic tests performed a | HCV-Ab, EV71, HBsAg, HEV, malaria Ag, H. pylori, HIV, CBC, CRP, ultrasound, X-ray, urinalysis, and blood culture | CBC (5), X-ray (2), ultrasound (2), blood culture (1), and AFB (1) | None, rely on patient symptoms (7 f); Giemsa stain (1); and malaria Ag (1) |
| POC tests available b,e | SpO2, HCV-Ab, EV71, HBsAg, HEV, malaria Ag, H. pylori, and HIV | 6 Sites d; ultrasound (1), HBsAg (1), HCV-Ab (1), SpO2 (1), ECG (1), BP (1), and none (1) | None (4), ultrasound (3), ECG (2), urinalysis (2), malaria Ag (1), and BP (1) |
| Referral hospital c | Hue Central Hospital in severe cases | Hue University Hospital (3); Hue Central Hospital (2); and none, treat at the district hospital (2) | Hue University Hospital (4), nearest district hospital (4), and Hue Central Hospital (3) |
| Patients with HIV/Sexual Transmitted Diseases | |||
| Diagnostic tests performed a | HIV rapid test, HBsAg, HCV-Ab, and pap smear | HIV rapid test (4); HBsAg (2); none, rely on patient symptoms (1); pap smear (1); gonorrhea gram-stained smear (1); CBC (1); urinalysis (1); and gram stain (1) | None, rely on patient symptoms (7) |
| POC tests available b,e | HIV rapid test | HIV rapid test (4), HBsAg (1), and syphilis rapid test (1) | None (4) and urinalysis (2) |
| Referral hospital c | Treat patient, do not transfer | Hue University Hospital (4) Hue Central Hospital (4), and Center for HIV/AIDS Control (2) | Hue University Hospital (4), Hue Central Hospital (3), nearest district hospital (3), and Center for HIV/AIDS Control (2) |
| Patients with Sepsis | |||
| Diagnostic tests performed a | CBC, urine creatinine, ALT, AST, electrolytes, procalcitonin, lactate, coagulation, and CRP | CBC (6); blood culture (2); ultrasound (1); and none, rely on patient symptoms (1) | None, rely on patient symptoms (7) |
| POC tests available b | SpO2 | SpO2 (2) and BP (2) | None (4), ultrasound (2), ECG (2), urinalysis (2), and BP (1) |
| Referral hospital c | Treat patient, do not transfer | Hue University Hospital (6) and Hue Central Hospital (3) | Hue University Hospital (5), Hue Central Hospital (5), and nearest district hospital (2) |
| Patients with Digestive Symptoms | |||
| Diagnostic tests performed a | Ultrasound, CBC, CRP, amylase, and lipase | Ultrasound (6); CBC (2); X-ray (2); LFT (1); AST (1); ALT (1); stool smear (1); rectal, sigmoid, esophageal endoscopy (1); and none, rely on patient symptoms (1) | Ultrasound (4); none, rely on patient symptoms (4) |
| POC tests available b | SpO2 | 6 sites d; none (3), ultrasound (2), SpO2 (1), and BP (1) | Ultrasound (5), BP (1), and none (2) |
| Referral hospital c | Treat patient, do not transfer | Hue University Hospital (5); Hue Central Hospital (3); and none, treat at the district hospital (1) | Nearest district hospital (4); Hue University Hospital (4); Hue Central Hospital (3); and none, treat at the community health center (1) |
| Patients with Respiratory Symptoms | |||
| Diagnostic tests performed a | CBC, blood gas, CRP, ECG, and PFT | X-ray (5); none, rely on patient symptoms (2); CBC (2); AFB (1); SpO2 (1); ECG (1); and fluorescent microscopy (1) | None, rely on patient symptoms (7) |
| POC tests available b | SpO2 and ECG | None (4), SpO2 (3), ECG (2), integrated BP monitor (2), and cardiac monitor (1) | None (4), ultrasound (3), ECG (2), and BP (1) |
| Referral hospital c | Treat patient, do not transfer | Hue University Hospital (5); Hue Central Hospital (3); and none, treat at the district hospital (1) | Hue University Hospital (4); Hue Central Hospital (3); nearest district hospital (3); none, treat at community health center (1); and Tuberculosis and Respiratory Diseases Center (1) |
| Patients with Asthma | |||
| Diagnostic tests performed a | CBC, blood gas, and PFT | CBC (3); none, rely on patient symptoms (2); SpO2 (2); AFB (1); X-ray (1); and PFT (1) | None, rely on patient symptoms (7) |
| POC tests available b | SpO2 | None (3), SpO2 (3), ECG (1), BP (1), and cardiac monitor (1) | None (4), ultrasound (3), ECG (2), and BP (1) |
| Referral hospital c | Treat patient, do not transfer | Hue University Hospital (5); Hue Central Hospital (3); and none, treat at the district hospital (1) | Hue University Hospital (4), Hue Central Hospital (3), nearest district hospital (3), and Tuberculosis and Respiratory Diseases Center (1) |
Abbreviations: AFB, acid-fast bacilli; ALT, alanine aminotransferase; AST, aspartate aminotransferase; BP, blood pressure; CBC, complete blood cell count; CRP, C-reactive protein test; ECG, electrocardiograph; EV71, enterovirus 71; HBsAg, hepatitis B surface antigen test; HCV-Ab, hepatitis C antibody test; HEV, hepatitis E virus rapid antibody test; HIV, human immunodeficiency virus rapid test; H. pylori, helicobacter pylori; LFT, liver function test; malaria Ag, malaria surface antigen test; PFT, pulmonary function test; SpO2, peripheral capillary oxygen saturation. Footnotes: a Survey question 3.29, b question 3.31, and c question 3.30. Respondents were allowed to give more than one answer per question. d Six district hospitals provided responses. e Many rapid POC tests for infectious diseases are not performed near patients’ bedsides. Patients’ blood is drawn and then taken to the laboratory 1–2 floors away for the actual test to be performed. f In most cases of infectious diseases, the patients’ clinical symptoms are primarily used.