Evaluation of Point of Care Tests in primary care: bridging the gap

Over the last decade, Point of Care testing (POCT) in primary care has become a crucial part of family practice, enabling general practitioners and healthcare personnel to provide better services to patients. COVID-19 has elevated the importance of POCT in primary care. This has dramatically shifted the paradigm, enabling healthcare providers to assess a patient’s condition shortly after first contact and to expedite treatment based on the diagnosis. 

Furthermore, COVID-19 shed light on how POCT supports efficiency in clinical decision-making  and highlights its necessity and utility in the fight against potential future pandemics.

The global in vitro diagnostic market has grown significantly over the past several decades and is projected to grow from $USD 97 billion in 2021 to $USD 149 billion by 2028.¹ Therefore, it is vital to understand the following:
 

• How POCT plays a role in combating serious conditions like COVID-19 and antimicrobial resistance
• The limitations in incorporating POCT into the community
• How to create regulatory guidance that will ensure POCT continues to benefit patients

Since their inception, COVID-19 tests have been critical in combating the coronavirus, and will remain important to inform regulations as new strains arise. As health threats continue to emerge, we can apply the learnings from COVID-19 to improve the sustainability and productivity of overstretched healthcare systems.

Over the past year, POCT for COVID-19 has enabled individuals to quickly determine if they have been exposed to the virus, allowing them to seek appropriate care based on symptom severity. Rapid COVID-19 testing has aided in the balance of in-patient visits to healthcare facilities and general practitioner offices, as to not overwhelm them based on capacity limitations for the optimal safety and well-being of all involved. Incorporating COVID-19 testing right at the point of care will continue to reduce transmission and allow physicians to quickly provide patients with optimal care. 

In order to get ahead of future healthcare crises and anticipate the best-case scenarios if another pandemic occurs, we need to continue to invest in POCT and focus on implementing it in primary care. Ensuring tests are reliable, cost-effective, and sustainable will be key factors in making significant progress in this area.

Before COVID-19, the clinical utility of POCT in primary care was evident in relation to other infectious diseases, more specifically, antimicrobial resistance. Antimicrobial resistance occurs when antibiotics are no longer effective at killing bacterial pathogens. The overuse and overprescription of antibiotics is the main factor that causes antimicrobial resistance and has become a major challenge in primary care facilities.²

A systematic review and meta-analysis conducted by Martínez-González and colleagues demonstrated that POCT for C-reactive protein (CRP) can help identify which patients with a respiratory tract infection need antibiotic treatment, reducing unnecessary antibiotic prescribing in primary care and thus decreasing the likelihood of antimicrobial resistance.³ Additionally, healthcare authorities are pushing the agenda with CRP POCT guidelines in the primary care setting to address the unnecessary prescriptions for immediate administration of antibiotics.⁴

Other conditions that lend themselves to POCT in primary care include influenza and heart failure.^5,6 POCT for these diseases ensures that patients receive the most appropriate treatment. Additionally, if POCT can be ordered quickly and the results made available within a single consultation, practitioners can make important decisions about care quickly, including referral and admission to emergency departments as needed.

When implementing community or POCT in primary care, there are several questions that healthcare managers need to answer for this testing structure to be successful. 

• How can we implement proper data management and oversight?
• Does POCT improve clinical care and clinical decision-making?
• Can we ensure analytical performance is maintained over time? 
• Is the POCT overcomplicated with multiple instruments and cartridges?

It is crucial that healthcare leaders find pathways for physicians and healthcare professionals to deliver these tests rapidly and efficiently through training, decision support and best practice guidelines. It is unreasonable to expect general practitioners to become as proficient as lab technicians in administering POCT. However, it is vital that clinicians and other personnel are trained to perform the tests at scale and understand the next steps that need to take place when errors occur. 

Close collaboration with clinical labs can expand and optimize POCT within the community care setting, such that testing is performed to the highest quality.

In order to expand POCT into primary care, national and local government officials need to create a regulated plan that provides guidelines to support and protect stakeholders who offer POCT. As an example, Belgium currently lacks a legal framework for POCT outside of the hospital. In a recent article, POCT experts proposed ways that Belgium can incorporate a set of priorities to continue movement in the right direction, including:⁷

• Certification of clinical laboratories for decentralized tests in primary care
• Introduction of a separate reimbursement category
• Reimbursement for a small range of POCT
• Establishment of a POCT advisory council  

While these features were put forth specifically for the Belgium market, other countries can incorporate similar prerequisites to bring POCT into primary care seamlessly.

There are five important factors that are absolutely essential for the successful implementation of POCT in primary care. Tests need to be:⁸

1. Accurate and reliable
2. Impact patient-relevant outcomes
3. Supportive of clinical decision-making with the result available at the time when the decision needs to be made
4. Cost-effective
5. Easy to use

Additionally, other criteria for POCT that would be ideal, but not necessary include: 

• Portability
• Multiple readings for monitoring
• Fast results within 2-5 minutes
• Non-invasive testing procedures
• Linkage to patient electronic health records (EHRs)

As we’ve seen with COVID-19, POCT enabled many countries to gain a better grasp on screening and monitoring, helping regions significantly reduce the community spread of the virus. Outside of COVID-19, early POCT in primary care can improve patient outcomes and potentially save lives.⁹

POCT will continue to aid in clinical decision-making in primary care, but it is important to note that it is only part of the solution. Practitioners need to use POCT as part of clinical reasoning and use it alongside the patient’s history and EHR. Equally as important is the consideration of appropriate legal infrastructure to seamlessly incorporate POCT outside of the hospital and into primary healthcare facilities. 

To engage, learn and gain inspiration from other industry leaders around topics of POCT, sign up for the ASPIRE point of care webinar series.