Patient testing outside of the pathology laboratory can take place in a number of locations including in the home, in the pharmacy and in the general practice surgery. To reflect these different locations which are all closer to the patient than the laboratory, this type of testing is often referred to as point of care testing or POCT.
The obvious advantages for the patient of home testing or POCT is convenience and some studies have also shown that it can be at least as clinically effective as conventional laboratory testing. The disadvantage is that there is the potential for the testing not to be performed to the same rigorous quality standards that exist in pathology laboratories. POCT devices are steadily improving in their capability but they are not fool-proof and users require some degree of training and the manufacturers’ instructions must be carefully followed.
Examples of POCT
There are many different devices available for patients, nurses and general practitioners to perform point of care tests.
The most common examples include:
- Pregnancy tests available from the pharmacy which measure HCG in the urine
- Glucose strips with meters which diabetics can use to check their blood glucose
- INR measurements performed in a doctor’s surgery for patients who are taking warfarin for a variety of conditions including atrial fibrillation and some cardiac surgery patients who have had a valve replacement.
Other less common tests which can be performed at point of care are:
- Lipid measurements including cholesterol, triglyceride and HDL for patients taking lipid lowering drugs
- Glycated haemoglobin (HbA1C) for monitoring patients with diabetes
- Haemoglobin (Hb) to screen for anaemia
- Luteinising hormone (LH) to predict ovulation
- Faecal occult blood to screen for bowel cancer
Point of care testing in Australia
With the exception of pregnancy and glucose testing, the amount of point of care testing is limited, primarily because patients cannot currently be reimbursed for such tests; if POCT is performed patients will usually have to meet the cost themselves which can be substantial.
Allowing for such tests to be reimbursed in general practice has been under discussion in Australia for some time. To help guide decisions in this area an extensive randomised controlled trail of POCT in general practice for a number of tests was performed some years ago. The results of the trial showed that POCT was well liked by both patients and GPs, there were some modest clinical benefits for some tests, but the cost of such testing with the exception of one test was more expensive then central laboratory testing.
At the current time the Commonwealth Government has made no decision to extend reimbursement to allow GPs to perform POCT. Despite this, more GPs are performing some tests in their practices, usually for INR measurements.
To help ensure that this testing and other types of POCT are conducted to the highest possible standard, a web-based organisation called the Australian Point of Care Testing Practitioners Network (APPN) and funded by the Department of Heath and Ageing, has been established to provide education, training and certification in POCT for practice nurses or any other healthcare professionals performing POCT in the community. The APPN website also provides recommendations about devices and how they should be used.
Guide to home testing
Home testing offers a way for you to test for medical conditions in your own home and to monitor chronic conditions such as diabetes and hyperlipidaemia. However there is the potential to get erroneous results from these devices. In addition there are devices which do not perform to the required standards and should not be used. The following guide is provided to avoid these problems.
Any device you use should be purchased from a reputable supplier such as a pharmacy and all devices sold in Australia have to meet standards set by the Therapeutic Goods Authority (TGA). This does not apply to devices sold over the internet with the risk that they may give incorrect results.
Some of the chemicals used in POCT devices are marked with an expiry date. Do not use if the expiry date has passed as you may obtain wrong results.
Follow the instructions on the test package on where and how to store the test. Many test components are temperature sensitive and may require refrigeration until they are used.
Before performing the test, note whether the tests need to be performed at specific times such as morning or evening, or under any special conditions such as fasting or no physical exertion. eg if you are testing for glucose it is important you wash your hands before performing the test, particularly if you have just eaten, as not doing so may lead to you obtaining the wrong results
In order to get the correct results it is essential to follow the instructions that come with the POCT device. If you have any concerns about how to conduct the test consider talking to your doctor or check with the APPN site listed below.
If you have any doubts about what the results mean, talk to your doctor.
Other information about POCT
For other information about point of care testing see the following organisations or links: