Publicado en

In this Q&A article, we look at some key questions healthcare professionals may have about point-of-care testing (POCT). We cover how POCT can be of value within specific clinical fields and in clinicians’ day-to-day roles, including discussion of how POCT may contribute to faster results, greater flexibility for patients and reduced antibiotic prescribing.

Perspectives in point-of-care testing

en

In this Q&A article, we look at some key questions healthcare professionals may have about point-of-care testing (POCT). We cover how POCT can be of value within specific clinical fields and in clinicians’ day-to-day roles, including discussion of how POCT may contribute to faster results, greater flexibility for patients and reduced antibiotic prescribing.

What is POCT and what therapeutic areas does it cover?
With POCT, patients and their care providers can make management decisions at the time of the visit of a patient. Results are usually available within minutes and can be discussed with the patient immediately[1][2][3][4]. Besides potential clinical benefits, this offers the physician greater certainty for patients presenting without laboratory results[1][2][3][4]. POCT has the potential to improve practice workflow and thus leads to operational and economic benefits[5][6]. For patients, this is more convenient and has also been shown to increase understanding, motivation and satisfaction[1][3][4][5][7][8].

POC tests are available for a wide range of therapy areas (eg, cardiology, diabetes, respiratory, anticoagulation, blood gas and infectious diseases).

Why is POCT important to healthcare professionals?
In some situations, a timely decision is crucial, thus POC tests or benchtop devices have been established in the emergency department such as for the measurement of blood gas or cardiac markers[9][10][11][12][13].

For the management of diabetes patients, it has been shown that HbA1c POCT has improved testing frequency and led to lowered HbA1c values[8][14][15][16][17][18][19].

Performing a C-reactive protein POC test in ambulatory care reduces immediate antibiotic prescribing in both adults and children and decreases the rate of patients referred to secondary care[4][20][21][22][23].

What are the health advantages of POCT and screening?
POC tests (eg, for lipids) are optimal for screening in hard-to-reach populations[24][25]. In addition, when patients are visiting their doctor’s office and need laboratory testing, there are less opportunities for patients to get lost during the process with POCT because patients (or blood samples) do not need to be sent to the laboratory for blood collection and testing2. You can only treat a disease or prevent further disease progression when it has been identified.

What are the advantages to the wider healthcare system of implementing POCT?
One example of an advantage to the wider healthcare system is evident with POCT for CRP, which plays a key role in the fight against antimicrobial resistance (AMR). The review on AMR report chaired by Jim O`Neill in 2016 highlighted that without policies to stop the spread of AMR, the current estimate of ~700,000 deaths per year attributed to AMR could become 10 million every year – more people than currently die from cancer26. If antibiotics lose their effectiveness this will have a large impact on healthcare in general, and this will lead to increased healthcare burden and cost for societies worldwide[26]. O`Neill estimates that the cost in terms of lost global production between 2016 and 2050 would be ~100 trillion USD if action is not taken[26].

CRP POCT has been shown to reduce antibiotic prescribing without affecting the safety of patients, as recently concluded by the European Network for Health Technology Assessment (EUnetHTA)[20]. However, despite this, CRP POCT is still not reimbursed in many countries.

How has COVID-19 impacted POCT?
During lock downs, most patients stayed at home and laboratory testing decreased. Telemedicine has been widely used as an alternative[27]. The WHO conducted a survey in 155 countries in May and found that prevention and treatment services for non-communicable diseases (NCDs) have been severely disrupted since the COVID-19 pandemic began[27]. They concluded that a long-term upsurge in deaths from NCDs is likely[27].

For those patients who need to consult their physician during this pandemic, the key advantage of POCT is that treatment decisions can be achieved with just one single office visit and additional unnecessary contact by visiting the laboratory or returning for further consultation can be avoided[2][3][5]. This is especially important given that people with diabetes, cardiovascular disease or cardiovascular risk factors, who contract COVID-19, are at greater risk of poor outcomes than the general population[27][28].

Why is it important to ensure that healthcare professionals keep up to date on POCT?
POCT offers multiple advantages for healthcare providers and for patients. New POCT devices are continually entering the market, new studies are published, and guidelines are evolving[25][29][30]. Staying informed regarding POCT can help practices continue to innovate and offer an elevated and efficient standard of care for their patients. Understanding how POCT can provide clinical benefits and understanding the analytical performance of various POCT devices allows clinicians to make informed decisions about practice optimisation[30][31].

Will the POCT landscape change as a result of COVID-19?
Several COVID-19 antigen and antibody rapid tests are now available[32], even molecular COVID-19 point-of-care tests[33]. COVID-19 POCT at test stations, in pharmacies and even at home is now possible[34][35].

Testing for NCDs like diabetes and cardiovascular disease has substantially decreased due to lockdown protocols, yet it is patients with diabetes and other underlying chronic conditions who are the worst affected if infected with COVID-19[27][28]. New channels and locations for POCT to allow for continued monitoring of parameters like HbA1c in patients with diabetes, during pandemic conditions, are critical[27].

A requirement of these new channels for testing will be to minimise both patient and clinician exposure; POCT can be a facilitator for this[1][2][3][4]. As an example, some clinicians are successfully innovating to offer POCT drive-through approaches[36]. As COVID-19 has accelerated the use of POCT in many places around the world[34][36], the advantages of the implementation of POCT may be experienced by more patients and clinicians alike. With this experience, it is possible that adoption of further POCT may be accelerated.

References

  1. Ivaska, et al. PLoS ONE. 2015;10(6):e0129920
  2. El Osta, et al. BMJ Open. 2017;7:e015494
  3. Plüddemann, et al. Br J Gen Pract. 2012;62(596):e224-e226
  4. Cooke, et al. BMJ Open Resp Res. 2020;7:e000624
  5. Patzer, et al. J Diabetes Sci Technol. 2018;12(3):687-694
  6. Crocker, et al. Am J Clin Pathol. 2014;142(5):640-6
  7. Laurence, et al. Br J Gen Pract. 2010;60(572):e98-104
  8. Shepard. Clin Biochem Rev. 2006;7:161-170
  9. Peacock, et al. Ann Lab med. 2016;36(5):405-12
  10. Dupuy, et al. Clin Lab. 2017;63:851-854
  11. Ryan, et al. Ann Emerg Med. 2009;53:321-328
  12. Singer, et al. J Emerg Med. 2015;33(6):776-80
  13. Mirzazadeh, et al. Emerg Med J. 2016;33:181-186
  14. Egbunike, et al. Diabetes Educ. 2013;39(1):66-73
  15. Rust, et al. Int J Healthcare Qual Assurance. 2008;21(3):325-35
  16. Miller, et al. Diabetes Care. 2003;26(4):1158-63
  17. Petersen, et al. Diabetes Care. 2007;30(3):713-5
  18. Cagliero, et al. Diabetes Care. 1999;22(11):1785-9
  19. Pillay, et al. SAMJ. 2019;109(2):112-115
  20. O’Brien, et al. EUnetHTA report 2019. Project ID: OTCA012. Available at: https://eunethta.eu/wp-content/uploads/2019/02/EUnetHTA_OTCA012_CRP-POCT_31012019.pdf
  21. Butler, et al. N Engl J Med. 2019;381(2):111-120
  22. Verbakel, et al. BMC Medicine. 2016;14:131
  23. Verbakel, et al. BMJ Open. 2019;9:e025036
  24. Jain, et. al. Ann Clin Biochem. 2017;54(3):331-341
  25. Nichols, et al. J Appl Lab Med. 2020;5(4):762-787
  26. O´Neill. The review on antimicrobial resistance. Tackling drug-resistant infections globally: final report and recommendations. 2016. Available at: https://amr-review.org/sites/default/files/160518_Final%20paper_ with%20cover.pdf
  27. World Health Organization (WHO) NCD department. Rapid assessment of service delivery for noncommunicable diseases (NCDs) during the COVID-19 pandemic. Available at: https://www.who.int/publications/m/item/rapid-assessment-of-service-delivery-for-ncds-during-the-covid-19-pandemic
  28. Harrisson, et al. Cardiovascular Risk Factors, Cardiovascular Disease and COVID-19: An Umbrella Review. Report commissioned and funded by Public Health England May 2021. Available at: https://www.healthcheck.nhs.uk/latest-news/an-umbrella-review-on-cardiovascular-risk-factors-cardiovascular-disease-and-covid-19/
  29. American Diabetes Association (ADA). Standards of Medical Care in Diabetes-2021. Available at: https://care.diabetesjournals.org/content/44/Supplement_1
  30. English, et al. Clin Lab Int. 2018;42:12-14
  31. Lenters-Westra, et al. J Diabetes Sci Technol. 2019;13(6):1154-1157
  32. Centers for Disease Control and Prevention (CDC). Guidance for SARS-CoV-2 Point-of-Care and Rapid Testing. Updated June 2021. Available at: https://www.cdc.gov/coronavirus/2019-ncov/lab/point-of-care-testing.html
  33. Krause, et al. Mol Cell Probes. 2021;58:101742
  34. Hardin, et al. Pharmacy 2020;8(4):182
  35. Hayward, et al. BMJ Open 2020;10(1):e033428
  36. Pollock, et al. J Clin Microbiol. 2021;59(5):e00083-21

Noticias relacionadas

Cards