Point of care testing
The evolution of PCR diagnostics
James Beckett explains how the use of molecular point of care testing (POCT) has seen exponential growth in recent years, from its hospital-based origins to its widespread community use for detection of infections, sexual health screening and, more recently, respiratory disease diagnosis during the COVID-19 pandemic.
Healthcare systems throughout the world face challenges in delivering effective, accessible and affordable care to an increasingly elderly population with a rising incidence of complex comorbidities. Successful care requires the provision of high quality, proactive interventions within primary and secondary care settings to limit unnecessary hospital admissions.1 As a result, many POCT technologies have been repurposed or developed to improve the convenience and efficiency of the patient care pathway outside of conventional hospital settings.
The evolution of point of care testing Diagnostic testing performed in a hospital laboratory setting can lead to unavoidable delays in results, potentially extending the duration of hospital stays, and increasing the cost of care and risk of disease transmission between patients. POCT or near-patient testing has existed in hospital settings for many years,
with routine diagnostic tests – such as urine testing or blood gas analyses – performed at or close to the patient’s bedside.2
However,
for more complex diagnostic assays, including molecular testing, biological samples traditionally needed to be transported to a laboratory for analysis. The logistics of this, combined with the potential demand on central laboratory workflows, could cause delays in the turnaround of results, leading to suboptimal or postponed treatments.
Implementing technological innovations Historically, POCT was viewed by laboratories as inferior to centralised analytical techniques, due to the quality of assay results available using older methods and instruments. However, recent advances in the automation and robustness of analytical technologies have led to widespread implementation of molecular POCT, adapting traditional healthcare models to better serve patients. Modern POCT allows
healthcare staff to perform a wide range of accurate PCR analyses close to the site of patient care, without the need for complex laboratory equipment or a high level of user training. The main objective is to generate results quickly, so that prompt decision making and early interventions can take place to ultimately improve clinical outcomes. These technological innovations have led to
the development of highly portable laboratory equipment that uses simple, semi- to fully automated protocols to analyse biological samples – including blood, saliva and urine – with just a few manual steps, generating timely results that can immediately benefit the patient. The speed and accuracy of PCR-based POCT has improved in recent years. Previously, technology did not exist to enable this kind of on-the-spot analysis, but the benefits are obvious. It is convenient for patients, eliminates barriers for patients who do not have easy access to traditional healthcare settings, and enables immediate follow up on results for cost- effective assessment and treatment. Modern healthcare has become better at focusing on user-friendliness, and ever-improving technology within this sector benefits both patients and healthcare providers, accelerating the testing process and allowing the right people to access results, and to act on them quickly and efficiently.
A patient-centred approach PCR-based POCT technologies are increasingly being implemented across a wide range of primary and community care settings, from doctors’ offices and paramedic support vehicles to sexual health clinics, drug and alcohol centres and prisons, as well as in isolated locations such as cruise ships. This expansion is supported by the near-universal recognition that modern healthcare needs to be less fragmented and more patient centred.3 The flexibility and convenience of POCT in the
March 2023 I
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