SensUs Interviews:
Rogier Hopstaken

For this edition of SensUs Interviews, we spoke with Rogier Hopstaken, member of our committee of recommendation. Rogier has the unique position to be both a general practitioner (GP) for 14 years and an expert on point-of-care testing (POCT). POCT is an important process in the diagnostics of patients, which SensUs wants to stimulate. Moreover, he works at Saltro, one of SensUs's first sponsors.

1. Who are you and what are your daily activities in Saltro?
I am a general practitioner who combined his GP training program with research at Maastricht University. While working as a GP at Meerhoven Primary Health Care Center in Eindhoven I have continued research, innovation and implemention activities, mainly in the fields of diagnostic testing, respiratory tract infections, antibiotics, and point-of-care testing. Currently, I am Head of Innovation and the Medical Staff and member of the Management Team of Saltro Diagnostic Center in Utrecht. I am active in various commissions at the Dutch College of GPs (NHG) and author of the Dutch guideline on POCT in general practice.

2. What exactly is Point of Care testing?
Nobody knows. ツ That means, literally, it is any test performed at the point of care (e.g. at the bedside of a patient). Generally, the term POCT is mainly used for tests that otherwise require a central laboratory. To underline the fact that POCT is not 'a rapid test', but a process, including a chain of elements that need to be taken into account, we have developed a specific definition for the Dutch guideline on POCT in general practice.[1]

3. What is the added value of POCT for patients and GPs?
The result of POCT is available during the same consultation with the medical professional. This has several advantages. It helps the doctor to reduce diagnostic uncertainty, so a more accurate diagnosis will be made. Particularly in primary care, diagnosing illnesses with the doctor's 'eyes and ears' can be difficult, because the patient presents symptoms and signs that are often less explicit ('grey') than learned from medical textbooks ('black and white') or when presented in a hospital setting (later stage of illness, more severe illness). Therefore, additional, high-quality, diagnostic tools are of great importance.
The added value of POCT is considered largest for acute illnesses, mainly for safely excluding a particular serious illness. But patients, particularly, also greatly value the service aspects. Other advantages of POCT include the possibility of serial testing and (home) monitoring. Self-testing is of course closely related, and may be the result of the same, or similar, technical developments.

4. Can you give examples of diseases of which diagnosis and/or treatment has improved through molecular biosensors?
In 2005 I have defended my thesis on lower respiratory tract infections in general practice. An important finding was the great difficulty for GPs to correctly diagnose pneumonia. The added value of a blood test, C-reactive protein, was immense. If this test is performed at the point of care, patients profit from much better management decisions, including less unjustified antibiotic prescribing. We have proven this after introduction of a CRP POCT test device in general practice. Our results were validated in larger, European studies. Patients, nurses and doctors were very satisfied with the use of these devices and with the collaboration with the diagnostic center that facilitated this introduction (training, logistics, quality assurance, follow-up). After our studies, CRP POCT was introduced in various guidelines, and is now routinely used by 60% of the GPs in the Netherlands. Other examples include D-dimer POCT, but also 'classical' tests like glucose, urine testing and hemoglobin POCT.

5. Which diseases can be improved in the future in terms of diagnosis and/or treatments thanks to molecular biosensors?
Possibly many and, again, particularly for use in primary care, where additional testing is mostly not possible. I expect that early detection of illnesses (cancer, infections) and prevention of illnesses (cardiovascular, genetic) with new biomarkers and genetic profiling will reveal many opportunities with direct impact for healthcare.

6. How can SensUs contribute in these developments?
This is a great initiative. The international competition and international focus will enhance learning processes and may result in great collaborations, soon after the competition, or in the future. SensUs will definitely stimulate the development of new solutions for the - so many - opportunities to improve patient care and service, particularly when initiatives like these are aligned with the needs in health care.