Acceptability and accuracy of point-of-care monitoring of lithium levels.
Atkins M., Lagman C., Oloyede E., Colli C., Maughan D., Oliver D., Cipriani A., McGuire P.
BACKGROUND: Lithium is the gold-standard treatment for bipolar disorder, yet its use is often restricted by the logistical burden of regular venous blood sampling and laboratory monitoring. Point-of-care testing (POCT) offers a potential alternative, but evidence regarding acceptability and analytical performance is limited. AIMS: To evaluate patient and clinician attitudes towards POCT for lithium monitoring and analytically validate a novel POCT device (Medimate Multireader) against a reference laboratory method. METHOD: We combined patient and clinician surveys on attitudes towards lithium treatment and monitoring with an analytical evaluation of the Medimate Multireader, a novel POCT device. Survey data explored perceived barriers to lithium use and preferences for monitoring methods. Analytical validation assessed accuracy, bias, agreement and reproducibility compared with a reference laboratory method. RESULTS: Most patients and clinicians preferred POCT to conventional venous sampling. Many patients described venous monitoring as inconvenient and disruptive and indicated that they would be more willing to take lithium if home-based POCT were available. Clinicians identified the frequency and logistical demands of venous blood testing as the principal barrier to prescribing lithium. The Medimate Multireader demonstrated excellent analytical agreement with the reference method, with a correlation coefficient of 0.96 and mean bias and limits of agreement within the predefined ±0.2 mmol/L performance specification. The potential of the device for patient-operated home-based testing was viewed favourably by survey respondents. CONCLUSIONS: POCT for lithium provides a feasible and analytically robust alternative to venous blood monitoring. By reducing the logistical burden of regular venous sampling, a key barrier to lithium use, POCT aligns with National Health Service priorities for digitally enabled community-based care and may support improved access, safety and adherence.