Point-of-care testing (POCT) has been around since ancient times, with records showing that physicians have used uroscopy, or the practice of examining urine for visual substances or cues, as far back as the time of the Greek Empire.1
But as society has evolved, so has the technology of point-of-care testing.
Point of care has become a multi-billion dollar business.2 The demand for accessible tests has increased in recent years, due in part to the COVID-19 pandemic. The US market for glucose monitoring alone has increased from $3.5 billion to nearly $7 billion, and this trend can be applied to nearly every other commercially available point-of-care test.2
Definition at the point of care
Point-of-care testing includes any test performed by a qualified personnel near the patient with results available at the same clinical visit to support clinical decisions.3
Overall, the health care system spends about $2 trillion annually to approximately 330 million Americans.4,5 Although the United States spends more per capita than most other countries, it is consistently ranked among the worst performers.
Primary care in medicine is poorly funded and supported, and the demands of a growing population create an opportunity for pharmacists to fill the primary care gap.
Point of care allows pharmacies to combat population health issues, expand patient care services, and increase revenue at the same time. Depending on the state, pharmacists may require additional training or cooperative practice agreements to provide point-of-care.6
The primary purposes of point-of-care testing are to modify behavior, identify and monitor disease, and reduce barriers to use.6
Type of point-of-care testing
Traditionally, offices of primary care providers (PCPs) have used point-of-care testing to diagnose acute conditions (can).7 These tests are helping to improve patient outcomes in acute conditions, and now point-of-care tests are beginning to crossover into chronic disease diagnosis and management as well. PCPs are often used in point-of-care tests for diabetes, and usually determine levels of glycated hemoglobin A1C from blood samples.7
Common point-of-care tests include rapid flu tests and the COVID-19 antigen. Less common tests include drug test kits and those for iron or vitamin levels. Unique point-of-care testing is used to guide antimalarial treatment in low-resource settings.3 In general, areas that benefit from point-of-care testing are acute conditions, public health, and infectious diseases.
Why POCT makes sense
Many healthcare barriers lead to poor patient outcomes, including the lack of an accessible healthcare provider, health insurance, or transportation.8 The health care system is struggling to meet patients’ needs while dealing with a shortage of providers and other pressing public health concerns. In disadvantaged areas, point-of-care testing reduces patient burden, is accessible, and saves time.8
Nearly 90% of the US population lives within 5 miles of a community pharmacy, which makes the pharmacy accessible.9 The Public Preparedness and Emergency Preparedness Act authorized community pharmacies to provide COVID-19 at the point of care in addition to administering vaccines and prescribing treatments to eligible patients.8 Before that, pharmacists had a critical role in getting immunized against the 2019 measles outbreak, and before that, influenza A virus.10
In addition, patients reported being comfortable with the pharmacists. They visit pharmacies twice as often as they see prescribers because pharmacists communicate well to increase health literacy and patient understanding.8,9 Point-of-care tests provided by pharmacists shorten treatment time, and pharmacists can also recommend symptomatic relief for some conditions.11
Challenges of point-of-care testing
Integrating point-of-care testing presents obstacles. Pharmacies and retail locations that want to offer point-of-care point-of-care need to apply for a waiver of Clinical Laboratory Improvement Amendments, and policies and procedures are needed for staff training, especially if pharmacists work alongside providers.11 In addition, other healthcare providers may be reluctant, often due to a lack of awareness or confidence in the pharmacy service.12
Depending on the type of point-of-care tests used, the validity of the result may be a concern.
Sensitivity and specificity may be an issue because the general point-of-care test is less reliable than laboratory tests.12 However, US standards require an accuracy and reliability rate of 85% for marketable point-of-care tests,12 So it is much better than not taking the test at all.
Another major challenge is the lack of a provider center for pharmacists – who may not be directly compensated for providing point-of-care testing services.4 Finally, the documentation of pharmacist-led point-of-care testing in electronic medical records and the general public health system may cause an operational problem.
conclusion
Point-of-care and rapid tests are critical to chronic disease management and early intervention and emergency situations.12 A rapid test result can increase more timely decisions about treatment, reduce risks associated with infectious diseases, and lead to a decrease in the number of host cases overall.11 Expanding the practice of pharmacists could help reduce the burden on PCPs, especially given the national shortages expected to affect the United States in the next decade.4
References
1. Campbell Q. Point-of-care testing: (a little) past and (more) future. Center for Disease Control. Accessed December 1, 2022. https://www.cdc.gov/cliac/docs/april-2022/7_the-laboratory-perspective.pdf
2. Stuart C. US Diagnostic and Testing Market Size from 2015-2022, by Product. Statista. July 14, 2017. Accessed December 1, 2022. https://www-statista-com.ezproxy.lib.uconn.edu/statistics/726084/us-point-of-care-diagnostics-and-testing-market- size /
3. Optical A, Van den Broel A, Hayward G, McManus RJ, Sheppard JP, Verbakel JYJ. The effect of point-of-care tests in community pharmacies: a systematic review and meta-analysis. BMJ is open. 2020; 10 (5): e034298. doi: 10.1136/bmjopen-2019-034298
4. Salgado TM, Rosenthal MM, Coe AB, Kaefer TN, Dixon DL, Farris KB. Primary health care policy and vision for community pharmacy and pharmacists in the United States. Pharm Practice (Granada). 2020; 18 (3): 2160. doi: 10.18549/pharmpract.2020.3.2160
5. Philips RL. Primary care in the United States: problems and possibilities. BMJ. 2005; 331 (7529): 1400-1402. doi: 10.1136/BMJ.331.7529.1400
6. Point-of-care testing (POCT). National Community Pharmacists Syndicate. Accessed December 1, 2022. https://ncpa.org/point-care-testing-poct
7. Sohn AJ, Hickner JM, Alem F. Use of point-of-care tests (POCTs) by primary care physicians in the United States. J Am Boardfam Med. 2016; 29 (3): 371-376. doi: 10.3122/jabfm.2016.03.150249
8. Sahr M, Blower N, Johnston R. Patient perceptions of acute infectious disease point-of-care testing and treatment within community pharmacy settings. J Am Pharm Assistant (2003). 2022; 62 (6): 1786-1791. doi: 10.1016/j.japh.2022.05.027
9. Berenbrok LA, Tang S, Gabriel N, et al. Access to community pharmacies: a cross-sectional analysis of nationwide GIS. J Am Pharm Assistant (2003). 2022; 62 (6): 1816-1822 AH. doi: 10.1016/j.japh.2022.07.003
10. Hess K, Bach A, Won K, Seed SM. The roles of community pharmacists during the COVID-19 pandemic. j Pharm practice. 2022; 35 (3): 469-476. doi: 10.1177/0897190020980626
11. How retail clinics and pharmacies benefit from point-of-care (POC) testing. Makison. May 9, 2022. Accessed December 2, 2022. https://mms.mckesson.com/resources/managing-my-lab/how-retail-clinics-pharma-cies-benefit-from-point-of-care- poc-tests
12. The future of point-of-care and rapid testing. Ipsos. February 2022. Accessed December 3, 2022. https://www.ipsos.com/sites/default/files/ct/publication/documents/2022-03/Ipsos_Future%20of%20POC%20and%20Rapid%20Testing_March%202022 .pdfBOX
About the author
Jessica Pelliko He is a Doctor of Pharmacy candidate at the University of Connecticut College of Pharmacy in Storrs.