Point-of-Care Testing

The market for point-of-care testing is estimated to grow 9.8% between 2016 and 2021. There are a number of reasons for this trend.

Point-of-care testing is useful as medical care shifts to a focus on prevention, early detection, and managing chronic conditions. Point-of-care tests provide results in real time, rather than in hours or days, so they can help you and your providers make faster, and hopefully better, decisions about your medical care. With results in hand during your consultation, you can receive immediate follow-up testing or treatments without returning for another office visit. For example, if you are diabetic and have a point-of-care test for HbA1c , your healthcare professional can immediately work with you to modify your treatment plan if the result is outside your target value. . At home, glucose meters allow people with diabetes to tailor their insulin therapy. Such glucose testing makes up the largest segment of the point-of-care testing market.

Another example is the use of point of care testing to measure prothrombin time/INR in an outpatients clinic, to determine whether a change in a patients warfarin dose is required.

There is also a growing need for rapid screening for infectious diseases such as HIV, dengue fever, malaria, and influenza. Infectious disease tests are useful in community clinics and remote or resource-limited areas where there may not be access to a central laboratory or where infrastructure is limited for transporting samples. Infectious disease tests at the point of care can also lead to prompter treatment, which can prevent infections from spreading.

When time is of the essence, such as in emergency departments or at accident scenes, point-of-care tests provide immediate information about glucose levels, blood gases and electrolytes.

When used as part of a larger healthcare strategy, point-of-care testing can make diagnosis and treatment a smoother and more efficient process. Point-of-care tests are most beneficial when they are viewed as one step in a testing continuum that may begin at the point-of-care, but eventually leads to coordinated testing with a central laboratory.

When used properly, point-of-care testing can lead to more efficient, effective medical treatments and improved quality of medical care.

At home, point-of-care tests allow for more frequent and more consistent testing and can empower you to take control of your medical care. Ideally, the end result is higher quality care. For example, clinical trials have shown that individuals monitoring blood thinners (anticoagulants) like warfarin at home had fewer major complications from the treatment.

Point-of-care testing is also crucial in emergency situations and in the operating theatre. If someone is having a stroke, a POCT prothrombin time/international normalized ratio (PT/INR) test can be used to assess blood coagulation before the patient can be given stroke medications. Point-of-care tests are also used to measure coagulation during open-heart surgery and organ transplants.

When used in an outpatient clinic, point-of-care testing can reduce follow-up visits.. In one study, delivering the routine tests haemoglobin A1c, haemoglobin, and lipids at the point-of-care decreased tests ordered for each patient by 21%, reduced follow-up calls by 89%, and reduced patient follow-up visits by 61%. One concern with conventional laboratory testing is that people may not return for treatment if they have to go home and wait for results. This has been the case for HIV viral load and tuberculosis testing. In one study at a clinic in Ghana, point-of-care testing helped remedy this problem. When people seeking care at a tuberculosis clinic were offered HIV tests on the spot, they were more likely to also return for HIV care.

Point-of-care testing can also provide test results in locations where clinical laboratories don't exist or are too far away, like in the developing world, rural regions, or on cruise ships or even the space shuttle.

While many point-of-care tests are designed to be relatively simple and low risk to use, they are not error-proof. Individuals using point-of-care tests, even healthcare professionals, must be trained to use the device and carefully follow test directions. Some point of care tests, such as those used to adjust doses of medications, have the potential to lead to serious health consequences if not performed properly. Many large hospitals have point-of-care coordination teams to ensure that testing procedures are properly followed.

It's important that the convenience of point-of-care testing does not tempt users to apply them beyond their intended purpose or misinterpret results. For example, glucose meters and point-of-care haemoglobin A1c tests are designed only for monitoring diabetes and should not be used for diagnosis or screening.

You and your healthcare professional also need to be cautious when comparing test results from different sources. Just as test results may not be consistent from laboratory to laboratory, they may vary between point-of-care testing techniques, or between laboratory results and point-of-care results.

One major challenge is managing the data generated by point-of-care tests. When tests are performed at the point-of-care, it is important that the results are incorporated into your health record.

If you are performing point-of-care tests at home, it's best to seek professional guidance. For example, if you are monitoring a medicine like warfarin for anticoagulation, a testing mistake could lead to a blood clot or internal bleeding. That's why it's recommended that you learn to perform the test with professional supervision and have the result verified by a clinician before performing it at home and be monitored periodically to ensure consistent technique.

The results obtained by POCT may not be as specific or sensitive as centralised laboratory test results. For example, rapid influenza diagnostic tests (RIDTs) are available to help differentiate influenza (flu) from other infections with similar symptoms that must be treated differently. Depending on the method, RIDTs may be done in less than 15 minutes, however, they produce a large number of false-negative results. Confirmatory testing is therefore required in the laboratory by either PCR or viral culture.

Though self testing kits can offer speed, convenience and privacy, it is important for individuals using these tests to seek follow-up care and diagnosis. For example, home HIV tests detect only HIV antibody and not the HIV antigen, so they may miss some early infections with HIV. Furthermore, all HIV screening tests that are positive should be followed by a second, different antibody test for diagnosis, and should not stand alone to make a diagnosis.

Point-of-care testing is also unlikely to be able to provide results for all tests required as part of a diagnostic investigation. Therefore, laboratory based testing will likely be necessary after an initial test at the point of care.

In general, point-of-care tests should be viewed as a valuable tool for medical testing, but not the only tool. Since you benefit most when point-of-care tests and central laboratory tests are coordinated, it's important that point-of-care tests are not used in isolation.

For some conditions, like diabetes, point-of-care testing has already drastically altered how care is delivered and managed. With the market for point-of-care testing only expected to expand, it will continue to change the way healthcare is delivered, making care more patient-driven and focused, providing more data to support evidence-based medicine.

New point-of-care tests that may emerge in the future include new technologies intended to manage critically ill patients in A&E, in the hospital, or undergoing surgery, such as full blood count or tests for drug overdoses. And new tests may be developed for earlier cancer detection, such as cervical cancer. Point-of-care tests will also continue to be important for managing chronic conditions.

Infectious disease testing is the fastest growing area of point-of-care testing. These tests are intended to diagnose infections quickly, to allow timely treatment, limit their spread, and slow or prevent outbreaks. These may include point-of-care tests for Lyme disease, avian influenza (bird flu) and drug-resistant bacteria such as methicillin-resistant Staphylococcus aureus (MRSA).

In the developing world and remote rural regions, the use of point-of-care tests is motivated by the need for better options to make diagnosis and treatment of diseases like malaria, HIV, and tuberculosis more accessible and affordable. In the developed world, respiratory and sexually transmitted infections are areas where new point-of-care tests could help.

For the last two decades, efforts have been underway to develop new technologies to bring more tests to the point-of-care and to make the tests more sensitive and specific. Molecular techniques such as polymerase chain reaction (PCR) will likely be used to deliver new infectious disease tests at the point-of-care. Another big focus area has been lab-on-a-chip systems. These miniature devices are designed to rapidly automate every step of a laboratory test using very small sample sizes, without the need for manual handling of the sample.

Point-of-care testing is never likely to replace clinical laboratory testing. However, as technology evolves to meet the demand for more streamlined, higher quality healthcare, point-of-care testing will continue to be a growing part of your healthcare experience.

There are many point-of-care tests available in a variety of settings. Here are some that you may encounter: