The shift towards point of care testing as a faster and more efficient source than Laboratory measures

by Odelle Technology

Point-of-care testing (POCT) refers to any diagnostic test administered outside the central laboratory at or near the location of the patient. By performing the sample collection and data analysis steps in the same location POCT cuts down on transport and processing delays, resulting in the rapid feedback of test results to medical decision-makers. Over the past decades the availability and use of POCT have steadily increased in Europe and throughout the international community. However, concerns about overall utility and the reliability of benefits to patient care have impeded the growth of POCT in some areas. While there is no agreed-upon standard for how success should be judged, the increases in speed and mobility provided by POCT can lead to substantial advantages over traditional laboratory testing. When properly utilized, POCT has been shown to yield measurable improvements in patient care, workflow efficiency, and even provide significant financial benefits. However, important organizational and quality assurance challenges must be addressed with the implementation of POCT in any health care environment. To ensure maximal benefits it may be necessary to evaluate critically and restructure existing clinical pathways to capitalize better on the rapid test turnaround times provided by POCT.

In 2017: El-Osta A, Woringer M, Pizzo E, et al. Does use of point-of-care testing improve cost-effectiveness of the NHS Health Check programme in the primary care setting? A cost-minimisation analysis. BMJ Open 2017;7: e015494. doi:10.1136/ bmjopen-2016-015494 illustrated a cost-minimisation analysis using a mathematical model with alternative scenarios showed that the total expected cost of using POCT to deliver a routine NHS Health Check in the primary care setting up to the point of CVD risk score presentation is lower than the laboratory-led pathway from the NHS perspective. Laboratory-led pathway offers patients three times more opportunities to miss subsequent NHS Health Check-related appointments or to exit the care pathway compared with POCT pathway. Using POCT in this context could be more convenient for patients and offers GPs the ability to act as a ‘one stop shop’ to patients by delivering a complete NHS Health Check in a single sitting. Using POCT in routine general practice for this purpose will likely reduce overall programme costs while supporting an increase in coverage from existing levels.

Shifts in population demographics, climate change, and land-use patterns contribute to increased chronic disease prevalence and the potential threat of infectious diseases

Point of care testing has paved a new avenue for the future of many health systems to meet the demands of a rapidly transforming ecosystem. 

Due to shifts in population demographics, many of the world’s populations will have one out of five people over the age of 65 by the end of the decade. Coupled to urbanization and the tendency to live a more sedentary lifestyle, the number of people living with multiple, chronic conditions is likely to increase.2-4 Furthermore, climate change and changing land-use patterns such as land, maritime and air travel will increase the risk of disease emergence and spread in the coming decades, as exemplified by COVID-19.

Point of care testing has emerged as a necessary need to help meet healthcare system testing gaps

The pandemic highlighted the importance of and helped accelerate us towards extensive decentralized diagnostic networks and rapid testing with point of care testing. During the initial wave of the COVID-19 pandemic, healthcare facilities were stretched to the limit.5,6 Hospitals, urgent care clinics, and emergency departments had to handle all aspects of care, from testing individuals with mild symptoms to caring for seriously ill patients. In some cases, patients who should have accessed same-day emergency care (SDEC) were less likely to visit emergency departments out of fear of long wait times.

It quickly became unsustainable. Over time, more convenient, patient-centric testing centres began to pop up as well as the option to test at home with publicly available, commercial testing kits in which individuals could get results in minutes. Additionally, more home sampling services began to emerge such that patients were able to send their own samples to commercial labs.

By vastly increasing access to testing through decentralized diagnostics, in the future point of care testing has the potential to improve patient outcomes and reduce healthcare spending. Seeing the right patients, in the right health delivery point, at the right time is central to point of care testing success. To accomplish this, the public needs to be aware of diagnostic availability and referral services where patients can be treated in one visit at this newly established point of care testing centres.

Community-based facilities will help improve accessibility and patient outcomes

Community-based testing and point of care facilities are vital to ensure that patients have adequate access to testing resources. 

To conduct a successful community-testing program, healthcare executives need to find ways to identify and support clinical team members, from pathology laboratory personnel to clinical leadership to app-based data managers. This new ecosystem needs to be dynamic and integrated.

Additionally, as we have seen with the COVID-19 pandemic, mobile solutions are becoming more commonplace and significantly improving accessibility, allowing patients to conveniently get tested quickly and efficiently. Some areas that can be exploited for mobile accessibility include supermarkets, sporting venues, and concerts. Walk-in pharmacies were also tapped to boost access to point of care testing. 

point of care testing improves accessibility for patients living in rural areas that may have to travel far to visit their primary care physician. Furthermore, it provides more options for patients seeking care outside of normal clinic hours and for those who may not have a primary care physician. As point of care testing may help overcome some of the barriers to having diagnostic work done, it could lead to earlier diagnosis, which can benefit patient outcomes and disease management. 

Using these mobile units helps reduce the number of patients that would otherwise get tested in the hospital or clinical setting. Increasing testing accessibility and convenience also ensures that communities remain safe and comply with regional mandates or testing recommendations. At the same time, resources are better focused throughout the health system, allowing larger healthcare facilities to attend to more severe patient cases.

Several essential criteria that healthcare leaders may employ for successful community-based testing centres include, but are not limited to:

  • Ownership and managerial leadership at all levels of community-based testing ensures regular oversight, communication, and compliance to deliver the best care possible for patients
  • Publicity through reports detailing the success of the testing and how the benefits are sustainable
  • Awareness among the community so that individuals know where testing sites are available and when they should visit these sites (e.g., when they are experiencing mild symptoms vs. serious symptoms)

Decentralized diagnostics as a way to help decrease healthcare spending

Compared to centralized diagnostics, point of care centres are also a cost-efficient means to decrease healthcare spending. More specifically, by bringing diagnostic testing outside of hospitals, point of care testing reduces unnecessary hospital admissions and activity in acute care settings, controlling patient flow for a range of health conditions. 

Moreover, diagnosing patients earlier helps prevent the onset of more severe symptoms, and thus expensive therapeutic interventions and subsequent care in the hospital setting.

In a randomized trial evaluating the cost-effectiveness of point of care testing, researchers found that in some cases total direct costs to patients was less with point of care testing compared to pathology lab testing, including costs related to hospital admission.1 Another study showed that total expected cost for point of care testing is lower than laboratory testing.

Compared to the traditional centralized diagnostic centres, point of care testing can help reduce costs by:

  • Decreasing the need for follow-up appointments 
  • Introducing treatment intervention earlier
  • Avoiding unnecessary testing and prescriptions
  • Decreasing the length of stay at Emergency Departments to improve patient flow.

Overall, reducing unnecessary in-hospital admissions leads to better clinical interactions with those patients requiring emergency treatment. 

To ensure that decentralized diagnostics can minimize costs for the long-term, healthcare executives need to find ways to ramp up rapid decision-making. To do that, leaders should look to invest in innovative technologies, resources, and facilities.

Creating point of care networks 

Within the UK, point of care networks have been established using a hub and spoke model for pathology laboratories. These collaborations ensure that laboratory services are concentrated, workloads are consolidated, and tests are standardized.

Another form of collaboration for point of care testing is through integrated care systems, which include primary care networks. These networks consist of general practitioner offices, pharmacies, community diagnostics centres, and other health organizations merging to create larger entities that control a portion of on-site testing or enable equipment access with easily accessible locations. 

Creating cross-organizational teams and decentralized testing within these networks will improve patient management and institutional workflow.

Enhancing rapid testing and health solutions at home

Rapid testing has become common in the home. As a result, patients and the public are now more comfortable with self-testing and self-sampling. By adopting at-home testing, patients can identify certain conditions, as demonstrated by the COVID-19 testing kits that are now widely available in pharmacies, grocery stores, and by mail through government-sponsored programs.

Furthermore, telehealth and digital solutions with home testing results uploaded to mobile apps for medical review have become the preferred form of care for many individuals. Now, wearable technology and mobile devices link directly to physicians, who can be alerted if there is a need for clinical intervention. Additionally, to help avoid unnecessary travel and exposure to COVID-19, patients can book a telehealth appointment with their primary care physician or other specialists where the patient can meet with their healthcare team from their mobile device.

Both at-home testing and telehealth solutions have created a better form of patient care that has increased patient safety and outcomes and, at the same time, reduced healthcare spending and resource usage. Patients are now more likely to take control of their own health monitoring.

The value of point of care testing in planning for future health threats

In addition to being able to provide better access and cost-efficiency to healthcare, point of care testing will also be valuable to plan for future health threats. Emerging infectious diseases are seemingly on the rise due to increased globalization and climate changes.

Some of the areas which will aid in preventing the next pandemic include:

  • Ensuring adequate healthcare staffing support and introducing systems for working remotely
  • Guiding organizations at the national and regional level that affords rapid and efficient decision-making
  • Expanding point of care testing accessibility and usability, which can include repurposing equipment 
  • Identifying and addressing supply chain bottlenecks such as the delivery of consumables
  • Implementing quality assurance and rapid validation of new devices 
  • Troubleshooting and maintenance of equipment by training on-site staff or having specialized members on-call for emergencies
  • Managing IT, particularly informatics solutions for hardware and software
  • Clear contingency plans which can be rapidly mobilized

Decentralized diagnostics for sustainable healthcare 

COVID-19 has challenged our communities, placing significant socio-economic burdens on our healthcare systems, but also paved the way for innovative solutions to combat disease transmission and make plans for future healthcare crises. 

With point of care testing and decentralized diagnostics readily available, individuals can now take appropriate measures for personalized care, from the convenience of their home or more accessible point of care facilities. Furthermore, health professionals can now share the burden of care via community-based testing sites and through large networks of pathology laboratories and primary care facilities.

Having foresight into how population demography and environment is evolving and the challenges plaguing our health systems today, we can help shape healthcare systems to best suit society’s needs. This calls for a decentralized and cooperative approach.

In the NHS NICE have a new Guidance that evaluates new, innovative diagnostic technologies. It includes all types of measurements and tests that are used to evaluate a patient’s condition.

Diagnostic technologies may be used for various purposes. These include:

  • ruling in or out a specific disease
  • general examination looking for clues to the cause of the symptoms
  • staging, or additional testing to assess how advanced or severe the disease is
  • monitoring a patient over time to determine changes in their condition
  • screening tests to look for conditions in patients without signs or symptoms of the specific condition.

The UK has an immense interest on antibiotic stewardship and Odelle have with elements of the University community in the UK and the NHSE taken the work of the INHALE Project Team. There work outlined the potentials, with respect to antimicrobial stewardship, of the various rapid diagnostics relevant for pneumonia, including (i) those that examine human biomarkers as predictors of infection type, (ii) those already widely used that seek respiratory viruses, and (iii) those now reaching the market that use PCR or rapid phenotypic testing to seek ranges of bacterial pathogens and antibiotic resistance genes. Sequencing-based tests are for the future, but they have potential to be far more comprehensive than PCR, particularly with respect to predicting resistance. It is likely that no single approach will be overwhelmingly successful but that collectively these approaches will facilitate a major shift in the management of respiratory infection.

Although POCT has the greatest potential as bedside tools, their use for pneumonia patients will need strong microbiology and/or infectious disease advice if their often-complex findings are to be best-translated into treatment advice and antimicrobial stewardship. Perhaps the biggest barriers to change and progress are people and tradition; deployment of these tests will demand significant changes to the ways of working both in the clinic and in the microbiology department. In closing, it should be added that COVID-19 seems certain to drive major changes in hospital practice, the virus may prover a driver to much wider changes in diagnostic practice.  Every year, hundreds of thousands of Europeans acquire potentially life-threatening bacterial infections while in the hospital, nursing home, or other health-care settings [1]. Such infections can be caused by a variety of bacteria, which may respond quite differently to different antibiotics. To match a patient with the most appropriate antibiotic therapy, it’s crucial to determine as quickly as possible what type of bacteria is causing his or her infection. To improve that process, HAS are funding a large team to help develop a point-of-care system and smartphone app aimed at diagnosing bacterial infections in a faster, more cost-effective manner.

IPSOS Future of POC and Rapid Testing:

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