It has been suggested that one way of reducing health care costs is to enable people to stay at home longer under appropriate treatment and care regimens and by supporting early discharge from hospital to home (Lehmann). Point of Care Testing (POCT)is one tool that may support such strategies (Lehmann). There have been several reviews of the place of POCT (Delaney etal, Guibert etal, Hobbs etal). These reviews all document the potential for POCT. However, they also note a lack of economic evaluation and little in the way of unbiased assessment of the effect on patient outcomes.
There are several definitions of POCT (Delaney etal, Price, Gutierres etal ) for this document the following definition is used:
“Any investigation carried out in a clinical setting or the patient’s home for which the result is available without reference to a laboratory rapidly enough to effect the patient management (Hobbs etal).”
This definition enables consideration of POCT in any primary care setting including the general practice and the community pharmacy.
Point of Care Testing is known by a wide range of names including (Huckle):
- Near Patient Testing
- Home Testing
- Rapid Tests
- Quick Tests
- Emergency Tests
Point of Care Testing is more expensive than testing through a central laboratory because of the loss of economies of scale (Hickle, Price). However, there are two clinical scenarios reported where POCT has relevance (Price):
- Where the speed of the result and acting upon it provides the best outcome.
- Where the result can manage the treatment of the disease.
The first scenario is typified in the management of a life threatening episode. The second typified by chronic condition management to support compliance with a long term therapeutic intervention strategy.
Studies such as the Diabetes Control and Complications Trial and the United Kingdom Prospective Diabetes Study have demonstrated that tighter control of blood glucose reduced the rate of secondary complications. A POCT strategy for this appears to be a practical option (Price). However, one study (Gutierres) showed that POCT in patients with diabetes showed no improvement in outcomes where patients had good control of their diabetes. The benefits for patients solely were with patients with poor control.
The literature is clear that POCT will only improve patient outcomes if the clinical team review the results and act upon them appropriately. Some studies have noted that failure to act on results has been problematic (Price). Thus, POCT must be linked to system and procedural changes to clearly improve patient outcomes. Without these changes patient outcome improvement is unlikely to be realised (Price, Gutierres etal., Huckle). There may be opportunities within the metropolitan Auckland context of consideration of POCT in implementing chronic care pathways and in improving access for high need populations for specific conditions such as diabetes.
POCT has been explored in for a range of tests including:
- H.Pylori
- Glucose
- Lipids
- Streptococcus A
- Potassium
- Pregnancy
- Haemoglobin
- Microurine
- INR
- Cardiac markers
- Some Microbiology testing
There are two safety issues associated with POCT:
1. Increased risk of exposure to possibly contaminated body fluids (Gutierres etal).
2. Disposal of biological waste and hazardous waste (Gutierres etal).
Additionally the literature notes that POCT should be under a quality control programme run by an accredited laboratory. Integration of data from POCT with routine laboratory data is recommended (Price). IANZ in a personal communication note that the success of POCT relies critically on the level of support provided by a parent laboratory in areas such as:
- Evaluation and purchase of POCT equipment
- Comparison of POCT equipment with reference laboratory equipment
- Development of a QA/QC programme for POCT equipment
- Training of users of POCT equipment.