POINT-OF-CARE TESTING
of all sore throat presentations, can be used. Such diagnostics are used routinely in other countries, backed by evidence that rapid testing in primary care for sore throats can reduce antibiotic prescribing by up to 25%.5
A sore throat test and
Fig 2. A number of lateral flow immunoassays (LFIAs) which detect various antibiotic resistance mechanisms are available from Una Health.
in the delivery plan for recovering urgent and emergency care services.
POCT diagnostics for antibiotic stewardship
Diagnostics play an integral part of such community care, particularly for frailty and respiratory patients. C-reactive protein (CRP) is a well-documented biomarker for the severity of infection, with point-of-care tests enabling clinical decision-making at the patient’s bedside. Una Health distributes the QuikRead go, a portable analyser that performs CRP testing from a drop of blood in a couple of minutes (Fig 1). This analyser can be used in accordance with the NICE Clinical Guideline for Pneumonia (CG191), as well as the recent guideline on suspected RTI in over-16s (NG237). These guidelines recommend CRP POC testing when clinicians are unsure based on clinical symptoms alone, to determine if patients will benefit from antibiotics. If the CRP level is more than 100 mg/L, antibiotics are immediately prescribed, but if less than 20 mg/L they are not offered, minimising unnecessary antibiotic use. In primary care, where 80% of
antimicrobial prescribing takes place, around 50% of all GP appointments for respiratory tract infections are prescribed antibiotics despite most infections being viral.1
This overprescribing is a significant
driver of antibiotic resistance, a growing public health crisis that resulted in 1.27 million deaths in 2019.2
The integration
of CRP testing in primary care facilitates antimicrobial stewardship by reducing
Una Health is a UK provider of diagnostics for the laboratory and point-of-care, based in Stoke-on-Trent.
WWW.PATHOLOGYINPRACTICE.COM APRIL 2024 15 prescribing by 23-36%.3 In addition
to tackling inappropriate prescribing, CRP testing has been shown to bring increased quality adjusted life years (QALYs) as well as cost benefits.4
In times
when our healthcare system is stretched and AMR has become one of the most pressing healthcare challenges globally, never has the adoption of CRP testing at the point of care been more imperative. The QuikRead go also performs
group A Streptococcus (GAS) testing. In the UK, around 8% of acute antibiotic prescribing is for patients presenting with sore throats. Like RTIs, most sore throats are viral and do not require antibiotic treatment. To further support clinical judgement and whether antibiotic treatment is needed, diagnostics for GAS, a type of bacteria that causes 5-30%
treat service was rolled out by the NHS in Wales in 2018, empowering community pharmacies to perform consultations and diagnostic testing for GAS, freeing up GP appointments. An analysis of pharmacy data in 2022 found more than 96% of users would have sought GP or emergency care. Furthermore, antibiotic prescribing was 21.3%, compared to 35- 83% of sore throat consultations with GPs not using a diagnostic, demonstrating the effectiveness of such services.6 In January 2024, the new Pharmacy First service was launched, enabling community pharmacies to consult and treat seven clinical conditions, including sore throat and urinary tract infections. This is part of a plan to free up GP appointments and provide more convenient care for patients. It is hoped that the use of diagnostics will be implemented in clinical pathways such as that in Wales, to improve antimicrobial stewardship.
POCT in diabetes management Point-of-care testing has also demonstrated significant benefits in diabetes monitoring. The global rise in type 2 diabetes cases, many of which remain undiagnosed, underscores the urgency of effective monitoring strategies. Testing for glycated haemoglobin (HbA1c) has become the standard diagnostic for diagnosing diabetes, offering advantages over plasma glucose levels which are affected by diet. Traditionally, HbA1c testing has been done using venous blood samples sent to testing laboratories. However, with devices like the QuikRead go, point-of- care HbA1c testing can be performed
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