Dr David Howdijam MD
In the early days of medicine, there were not many medical tests that could be performed at the patient’s bedside. By the 1980s, with the advent of automated technologies, clinical laboratories could run large numbers of tests at a much quicker time. However, with very few laboratories in existence, it became common to send samples away to laboratories and then wait days to weeks for the results. Today, as the need for faster test results has grown, the technologies involved have evolved dramatically accordingly. Many testing devices have become portable and are extremely user-friendly. While results from clinical laboratories remain a crucial component of healthcare, they are now complemented by tests performed outside of the laboratory, wherever the patient is.
What is Point-of-care testing?
Point-of-care (POC) testing spans so many areas of medicine that it is best defined by where it’s done – anywhere outside the centralised laboratory – rather than by the kinds of tests that are performed. It may be referred to by many different names, such as near-patient testing, remote testing, satellite testing, and rapid diagnostics. In general, point-of-care testing encompasses any tests that are performed near a patient and at the site where care or treatment is provided. Results are typically available relatively quickly so that they can be acted upon without delay.
Where is POC testing done?
POC testing can happen in a wide variety of locations – at home, at a healthcare practitioner’s office, in the emergency department, in an infectious disease containment unit, in ambulances, at an accident site, in the military, in the radiology department, on cruise ship, or even on a space shuttle. And a wide variety of persons can perform POC tests, including laboratory professionals, emergency first responders, radiologists, doctors, nurses, physician assistants, or other healthcare practitioners. They may even be done by the patients themselves, sometimes called “self-tests” or “home tests”.
Why is POC testing growing?
Healthcare, today is getting more consumer-focused and there is a need felt everywhere for convenient diagnosis, monitoring and screening tests. Like stated before, with the advancement of medical technology in general, testing devices have become smaller and more portable. Operating these machines are very simple that anybody could use them with ease. There is also a growing need for rapid screening for infectious diseases like dengue fever, HIV and influenza. Rapid infectious disease testing are also useful in community clinics or resource-limited areas there may not be easy access to a central lab or where the infrastructure is poor because of which transportation of the samples is difficult.
Examples of POC tests: There are many POC tests available in a variety of settings. Some of these are Blood glucose – for diabetes screening and monitoring; Activated clotting time – heparin drug monitoring; Haemoglobin/haematocrit – screening for anaemia; Rapid HIV – screening for HIV; Rapid HCV/HBV– screening for HCV/HBV; HCG – pregnancy testingp; Dipstick urinalysis – screening and monitoring of kidneys and urinary tract and diagnosing urinary tract infections; Rapid strep – diagnosing strep throat and Prothrombin time/INR – monitoring anticoagulant therapy.
Benefits of POC testing: POC testing, when used properly can lead to a more efficient and much improved quality medical care. These tests allow for more frequent and consistent testing when used at home and can empower a patient to take control of his medical care.
POC testing can be crucial in emergency situations and in the operating room. It can help reduce emergency room overcrowding by reducing the time it takes to treat people. POC testing is crucial in disaster situations when access to power, water and laboratory is unavailable. Helpful in remote places, on cruise ships or even the space shuttle where facilities for clinical testing is not there.
Reduces the need for follow-up visits when used in a healthcare practitioner’s office and when test results are available on the spot, a patient is more likely to return for medical care.
Caution when using point-of-care testing:
Despite the fact that POC tests are designed to be relatively simple and have low risks for use, they are not completely error-proof. To be able to use POC testing, individuals including healthcare providers must strictly follow test and machine directions and be familiar with the system. If not performed properly, some POC tests such as those used to adjust doses of medications have the potential to lead to serious health consequences. It is necessary that common people are not tempted to use POC testing beyond their intended purpose as it can lead to wrong interpretations.
Just as results are not consistent from laboratory to laboratory, they may vary between two different POC test techniques or between a conventional lab result and a POC test result. Some POC tests require professional supervision and are meant for use in hospital settings only during emergency situations. Though HIV, HCV and HBV POC tests can be done at home for convenience and privacy reasons, it is important that individuals understand that these tests are not error-proof and should seek follow-up care and diagnosis. Results in POC tests may not be as specific or sensitive as centralised laboratory results. POC tests may also deliver a limited range of results. Point-of-care tests should be taken as a valuable tool for medical testing but it can never replace a conventional laboratory’s results. POC tests are not meant to be used in isolation.
(The author is Consultant Pathologist, BABINA Diagnostics, Imphal)
Dr David Howdijam MD