How is Point-Of-Care Testing Set to Revolutionise Healthcare?
Author: Carla Elizondo
What is point-of-care testing?
Over the last year, we have seen a huge increase in interest around Point-of-Care Testing (POCT) as a direct result of the COVID-19 pandemic. POCT is defined as testing that is performed near, or at the site of the patient, rather than in the traditional environment of a clinical laboratory, enabling immediate analysis and subsequent treatment or intervention.
What benefits do POCT have in improving healthcare worldwide?
Often, the main objectives with patient care are quality, accuracy, speed, cost, and outcome. The implementation of POCT has a largely positive impact on the delivery of these objectives. One of the greatest benefits of POCT is the speed at which it can be performed, another being that it can be utilised by personnel who are not trained to test in a clinical lab environment.
This level of availability helps break down barriers associated with lab analysis diagnostics; allowing for answers to be delivered in real time, offering a diagnosis and treatment plan within a single visit. This creates many opportunities, such as helping to eliminate wait-time for results from a lab, while removing a layer of consultations and shortening the route to a diagnosis and treatment. Furthermore, POCT will have a significant impact in helping provide diagnoses in locations without access to a central lab, such as rural or economically deprived areas, making it a real game changer.
Rapid turnaround of test results is vital to decision-making across a range of healthcare settings. By having access to key test results on the spot, clinicians gain greater control in evaluating and responding to a patient’s ever-changing condition. Ultimately, such an improvement in providing fast, accurate healthcare will aid in alleviating stress on healthcare systems by addressing conditions before they become severe.
POCT allows for greater economic benefits
In addition to the obvious benefits to medical staff and patients, there are economic benefits that can result from the adoption of a with-patient testing platform. Improved efficiencies and productivity, simplified processes and procedures, as well as decreased specimen packaging and transportation time can lower the total cost of care. While up to 70% of medical decisions are based on laboratory tests, they only account for between 3-6% of total patient-care costs.1 Costs of optimised POCT, compared to core laboratory testing (whether centralised or outsourced), can provide even greater decision-making and greater savings if the technology is at the level we expect. An expensive POCT cannot replace routine laboratory testing if the cost increases strain on national health services or private healthcare providers.
Rapid test turnaround times improve time-critical decision-making and can result in total savings between 8-20% of laboratory costs for facilities that implement POC testing.2 The savings realised due to the decreased cost of waiting for results can be as much as $260USD (€148) per patient.3 For those that implement POCT, waiting can improve by as much as 46 minutes per patient.4
Given the benefits of POCT, why is it not more widely utilised?
An international survey among 2770 GPs in the UK, Australia, Belgium, the Netherlands, and the US has shown that GPs would like to use more laboratory POCTs. They specifically want POCTs to help them diagnose acute conditions, such as infections (C-reactive protein [CRP], chlamydia, gonorrhoea), acute cardiac disease (troponin, B-type natriuretic peptide), pulmonary embolism and deep-vein thrombosis (D-dimer), and some chronic conditions (for example, HbA1c, haemoglobin).5
With a clear demand for the technology, why is it not more widely utilised? Routine laboratory tests are tried and tested. They offer consistently reproducible results and, while individual materials may be expensive, the scale of testing significantly brings down the cost per test. Many clinicians are now also opting for accurate commercially marketed in vitro diagnostic kits as well as traditional laboratory-developed testing. These diagnostic kits are designed to operate across a spectrum of laboratory settings in laboratories with a range of experience6. The kits overcome some of the limitations encountered by laboratory-developed tests, eliminating some of the margin for human error and standardising testing. While POCT would be the next step in optimising diagnostics, by removing the involvement of any trained clinicians, GPs are concerned about test accuracy, over-reliance on tests, the use of diagnostics without a proper indication, and a lack of skills to safely use and interpret these diagnostics. Furthermore, most current technology cannot deliver a high enough standard of testing at an attractive price point, as large-scale testing remains the most reliable and cost-effective solution.
Furthermore, while tests such as blood glucose and pregnancy tests have been cheaply and readily available for years, it takes a strong R&D effort to develop a highly accurate test for a new application that is financially viable. Again, if a POCT is more expensive to run than current routine diagnostic methods, the strain on national health services will be increased, rather than reduced. Current technology is not ready to achieve POC performance for many target disease markers. Following the Sars-Cov2 pandemic, many nations quickly adapted well-established coronavirus PCR testing to test for infection in large populations as their protocols are more readily deployable and quicker to action at this point in time. Today, we are still funnelling resources into developing a reliable POCT that is better than alternative lateral flow tests to provide quicker result turnaround times and offer a better solution for population infection management.
Working towards resolving POCT limitations and making it accessible
Consistent proof of reproducibility of results, at a low cost and a time to result of under 10-15 minutes will be the key in increasing uptake and accessibility of POCT. At Integrated Graphene, we are collaborating with diagnostic companies to elevate their diagnostic tests to a highly sensitive, yet cost effective, microfluidic POCT powered by 3D Graphene Foam, Gii. Driven by a 98% pure large electrochemically active surface area, our Gii-Sens electrode offers unparalleled sensitivity for amplification-free, enzyme-free and label-free assays.
We use our extensive knowledge of microfluidic system development to support POCT device developers from concept to commercialisation. Our team of skilled scientists and engineers develop complex and effective microfluidic systems, delivering highly sensitive POCT devices for the wealth of specific applications our clients present.
Our in-house microfluidics expertise, powered by Gii, will unlock the next generation of POCT devices and bridge the gap between concept and implementation of providing better healthcare, worldwide. Gii-Sens overcomes each of the key barriers faced by POCT development. We can provide a low-cost, customisable solution without compromising on precision and speed. We strive to deliver gold-standard testing, at the low price of carbon, powering the next generation of accurate and fast POCT to enable better healthcare worldwide.
Do you have a POCT device you want to develop? Get in touch, we can support you and enable your device’s potential today.
References:
Forsman, Rodney W. “Why is the laboratory an afterthought for managed care organizations?” Clinical Chemistry Volume 42:5, (1996) 813-8162.
Schilling UM. The economic benefits of point-of-care testing. Hospital Healthcare Europe, special supplement. www.hospitalhealthcare.com
Schilling UM, Rönnersten A. Laboratory sampling according to triage – how much does it cost? SJTREM 2010;18(Suppl 1):P19.
Norgaard B, Mogensen CB. Blood sample tube transporting system versus point of care technology in an emergency department; effect on time from collection to reporting?
A randomised trial. Scand J Trauma Resusc Emerg Med 2012;20:71.Howick J, Cals JW, Jones C, et al. (2014) Current and future use of point-of-care tests in primary care: an international survey in Australia, Belgium, The Netherlands, the UK and the USA. BMJ Open 4(8):e005611.
Schreier, Feeny & Keeling. Diagnostics Reform and Harmonization of Clinical Laboratory Testing. DOI: 10.1016/j.jmoldx.2019.04.002