The PHOCUS (Point-of-Care Hospital Test for Clopidogrel Utility in Rural Scotland) project aims to understand the impact of Point‑of‑Care Testing (POCT) for genotype CYP2C19 in remote and rural settings, using Western Isles Hospital and Dr Gray’s Hospital as exemplars.

 

 

NICE guidance supports CYP2C19 testing primarily through laboratory services, with POCT recommended where lab access is limited. The evaluation will explore whether POCT can reduce turnaround times and improve clinical decision‑making for rural populations.

 

The greatest risk of a secondary stroke occurs early, meaning test results are most effective when delivered within 24 hours of symptom onset. In remote and rural parts of Scotland, samples must be transported long distances to genetic laboratories, creating delays that can impact treatment.

 

To understand whether the use of POCT technology significantly reduces the time to obtain genetic test results compared to standard laboratory practice in rural and remote areas. We will also be able to evaluate the costs of POCT compared to standard genetic testing and whether POCT is reliable and clinically valid in real‑world rural settings.

People who experience a non‑cardioembolic ischaemic stroke or TIA are routinely prescribed the antiplatelet medicine Clopidogrel to reduce the risk of another stroke. However, around 28.7% of patients in the UK do not benefit fully because of common variants in the CYP2C19 gene, which affect how the drug is metabolised. Genotype testing can identify these variants, helping clinicians choose the most effective antiplatelet therapy for each individual.

 

The evaluation uses the Genedrive® CYP2C19 ID Kit, the POCT system recommended by NICE.

NHS Grampian has been commissioned and funded by the Scottish Government to lead the innovation programme, clinical oversight, and project delivery.