Point of care testing


community benefits both patients and clinicians; tests are user-friendly to reduce patient anxiety, biological samples can remain on site, and there is minimal processing time required for analysis. The process also fits well within the patient care pathway; it removes barriers to further care and follow-ups, as both the patient and the results are right there with almost no delay. POCT can therefore improve patient satisfaction by enabling faster decision making and earlier treatment.3


In turn, treatment can be optimised


sooner, and patients are more likely to adhere to the intervention, leading to better clinical outcomes. Decentralising clinical testing also makes


laboratory diagnostics and screening accessible to a wider population. It reduces barriers to care for patients located in remote or rural settings by bringing the laboratory to the patient. This process means that even patients who struggle to access or engage with traditional healthcare services can benefit from testing, as they do not need to enter inpatient settings to seek care. It also eliminates some barriers for patients who experience stigma or anxiety surrounding certain conditions. POCT can destigmatise procedures like sexual health screening, making it something that patients can easily access and discreetly fit into their day. For example, when Dean Street Express opened in 2014, this was the first time I had heard of sexual health testing performed in a setting that offered a convenient walk-in service, online bookings and digital results. It was a completely new concept for patients.


Prioritising public health: maximising resources and minimising risk With recent advances in community diagnostics, it is crucial to understand the impact of molecular POCT at both the level of the individual and of the wider population. POCT lends positively towards public health initiatives of prevention, screening and monitoring of disease, and the promotion of health for the general public.4


PCR-based POCT provides a means of early disease surveillance, helping to reduce transmission and the need for widespread treatment. For example, in sexual health screening, reducing time-to-results from between two to 14 days to as little as one hour in populated areas can significantly reduce disease transmission. A further benefit of POCT is that it can address the public health threat of antimicrobial resistance5


by generating


rapid results and limiting unnecessary use of antibiotics. Efficient screening and testing through


POCT therefore enables a more effective use of resources in healthcare. It can reduce visits to community clinics and unnecessary hospital admissions, decrease the length of hospital stays, and place fewer demands on medical staff. The direct cost of molecular POCT may be perceived as more expensive than batch testing of samples in a laboratory, and requires an already overworked workforce to pick up new skills, but the overall benefits to the healthcare system outweigh the individual cost per test. Some of these were clearly and demonstrably experienced during the COVID-19 pandemic, where this approach reduced the need to isolate patients and freed up hospital beds, undoubtedly saving time, money and resources that were desperately needed for the most critically ill.


Collaboration to meet industry standards Successful care models require comprehensive regulation, and one of the main challenges facing molecular POCT is the perception that it is difficult to standardise, due to a wide range of healthcare professionals and laboratory staff conducting analyses across multiple sites. In addition, conducting POCT in various locations and environments introduces additional challenges, like device upkeep and


58 www.clinicalservicesjournal.com I March 2023


maintaining reagent quality under various conditions, making buy-in from laboratory personnel crucial.6


Successful implementation


requires medical and laboratory staff to work together to introduce and manage access to testing, but is beneficial to both parties: enabling healthcare staff to tap into laboratory expertise to learn new skills, while freeing up resources for laboratories to roll out new technologies and expand the services that they offer. Another regulatory challenge for POCT is that these diagnostic tests can be conducted by healthcare staff with limited technical background. Comprehensive training of medical staff and robust quality assurance are therefore critical.3


The healthcare model is


not the same across Europe, and the level of acceptability of POCT differs between countries. Implementing this approach requires a level of collaboration between healthcare providers and laboratories to meet standards and regulations. It is about balancing the safety and quality of testing to meet the same standard of accuracy as analyses that would be conducted in a laboratory, while optimising the ease of performing the tests outside of normal hospital settings to quickly and efficiently obtain results.


Looking ahead Currently, POCT can be carried out for an extensive list of conditions and targets. Rapid bedside tests can be used to monitor blood glucose, pregnancy, electrolytes, blood gases, creatinine, urea, haemoglobin, drug misuse, and therapeutic drug outcomes, while more complex molecular testing can be used to diagnose infections due to Streptococcus, influenza, HIV and, more recently, COVID-19.7 Positive experiences of POCT during the COVID-19 pandemic mean that, in the case of future health crises, the healthcare sector will have workable systems ready to scale up for monitoring early warning signs, detecting


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