The point-of-care diagnostics facilitated by point-of-care testing (POCT) represent significant progress in the area of diagnostic testing. POCT devices are smaller, portable and easier-to-use versions of laboratory testing tools. Compared to traditional lab tests, POCT allows for the timely acquisition of samples capturing health data when it’s most valuable. Data acquired by POCT helps practitioners make faster, more accurate decisions in real time.
POCT represents a decentralization of the conventional laboratory, which until now was a centralized, static, purpose-built facility, usually built by large hospitals.
POCT can be used by both medical practitioners and patients to closely monitor health markers to deliver care tailored to patients’ personal needs and facilitate broad point-of-care services.
Point-of-Care Testing Examples
POCT includes laboratory technologies that are simplified and miniaturized for use outside the laboratory setting. In other cases, it concerns devices that are able to collect samples or data that can be incorporated into the laboratory environment, typically by allowing the physical integration of the outside-the-laboratory device with traditional laboratory equipment.
There are four major types of POCT. Those administered near-patient (NPT), inside physicians’ offices, off a primary site or at an alternative site. Testing types represent both those that can be operated by patients and non-qualified personnel and those that are operated exclusively by qualified healthcare personnel.
The most common of these are near-patient testing devices, sometimes called “bedside” testing. NPT refers to tests that are designed for use by health professionals in the patient environment. NPTs generally provide rapid results and do not require further laboratory processing.
Point-of-Care Testing Settings
POC testing can be undertaken in the following settings:
- At home
- In paramedical services like an ambulance
- In a nursing home facility
- In a general medical practice
- In rural hospitals or health clinics
- At a critical care facility within a hospital
- In hospital clinics
- At a sports clinic
- In a workplace for a drug screening
Point-of-Care Testing Benefits
Many POCT is non-invasive, helping test a wider variety of patients more frequently. Patient apprehension represents a significant hurdle to regular testing; POCT allows for strides in both patient health and patient satisfaction with healthcare services.
Practitioners are able to get more done in a single visit as opposed to scheduling multiple visits or delivering results over the phone or online (requiring patient consent and introducing a risk to privacy). Patients can be empowered to track their own health indicators, working with physicians to proactively manage their health. .
Patients can take tests under a variety of conditions (i.e., exercising vs at rest) to obtain meaningful information based on a variety of internal and external factors.
As evidence-based medicine becomes the norm, it will rely on POC testing to facilitate a more responsive and data-driven approach to care. In cases where the fast, secure transfer of data is necessary, such as the scene of a natural disaster, secure and connected devices can send information anywhere in the world, automatically.
Point-of-Care Test Types
Point-of-care testing has been around for some time and continues to develop as the technology evolves and applications for tests expand.
Common tests include:
- Blood glucose monitoring
- Home pregnancy tests (hCG)
- Fecal occult blood
- Rapid strep
- Prothrombin time
- Oxygen saturation
POCT uses the following advanced technologies:
Qualitative strip: Examples: Strep tests, pregnancy tests and some urine analysis tests.
Unit analyzers: Examples: Whole-blood and plasma concentration blood glucose tests.
Benchtop: Examples: Immunoassays, blood-gas analyzers and spectrometry.
Hemostaseological coagulation analyzers: Examples: These measure blood coagulation.
Continuous measurement: Examples: Minimally-invasive continuous blood-glucose monitors.
Quality control is an important aspect of POCT testing. In order for decentralized testing to represent a leap forward, quality control measures regarding device use, data management, sample integrity, and result accuracy must be rigorous. POCT devices can be complicated and regulators, doctors, and patients should be educated in their appropriate and responsible application.
POCT devices employ quality control measures such as:
- Device selection: Knowing which devices to use in what setting and how to properly deploy them based on current conditions.
- Operator lockout: Features that prevent users from misusing them in an attempt to expedite or influence results.
- Device verification: Features that ensure use by the approved parties.
- Device control: Device tracking measures that help monitor and locate devices.
Health professionals must demonstrate competency in administering tests in a variety of conditions and the aptitude to interpret and apply results. Patients, especially those using continuous testing devices, should also be trained and supervised in their use. A doctor should supervise all health decisions made with POCT data.
Future of POCT
POC testing has and is expected to continue to lower the cost of testing, requiring less processing and manpower to produce the same data.
POCT has already provided gains in how care is delivered and managed for conditions like diabetes; empowering both patients and clinicians. Advancements will continue to simplify device use while improving accuracy. For instance, early pregnancy testing is already providing users with crucial information about their pregnancy status, sooner.
As was demonstrated in the COVID-19 pandemic, infectious disease detection will play a major role in public and personal health initiatives such as limiting infection spread and facilitating early treatment. This includes field tests for HIV, influenza, and Lyme disease. The impact of these tests will be felt most in developing nations and rural regions where access to quality testing is limited.
While traditional laboratory testing is expected to continue to play a role in testing, advancements in device miniaturization and so-called lab-on-a-chip systems will improve access to testing.