print   Print full article There are a growing number of tests that can be performed at point-of-care although the menu of tests is far less than the range performed in the central laboratory.

Two factors should determine the need for PoCT. The first is a clear understanding of why PoCT is being conducted. In other words, what is the clinical question being asked by your healthcare provider, who is usually your GP, and how will performing the test in the practice help them answer that question more effectively than sending the test to the central pathology laboratory. In the examples described in Table 1 we describe the reasons for testing.  

The second factor to consider is whether there is a PoCT device of sufficient quality to provide a reliable result that can be used for your care. Developments in technology have produced a range of different PoCT devices some of which have a similar analytical performance to those tests carried out in the pathology laboratory. For the test examples described, devices are available that produce results of the required quality.

However, it is important to emphasise that not all PoCT tests that are available are of the required quality and consumers and patients need to be aware of this, if and when they are offered PoCT.

Table 1  shows some of the tests that are being carried out in various point-of-care locations such as in the home, general practice, the pharmacy, and other healthcare facilities including small rural hospitals or clinics. Pictures of some of the devices used to perform these tests are also shown.
 
Table 1. Tests performed at a range of point-of-care locations and the reasons for testing
Point-of-Care Test Reason for testing Where performed?

Glucose
  • Diabetic patients routinely taking insulin need to monitor their blood glucose to guide their insulin dosage. They use glucose meters that measure blood glucose.
  • GPs and other health professionals including pharmacists may also use glucose meters to check the glucose levels of individual patients
Home, GP, Pharmacy, Hospital Clinic/Ward
INR
  • Someone taking  the blood thinning medication warfarin for a condition such as atrial fibrillation needs to have a regular INR test ­ (which is often performed by a GP) to calculate their correct dose of warfarin.
Home, GP
Haemoglobin
  • To see if someone maybe anaemic
GP
HbA1c
  • Diabetic patients, as well as checking their glucose levels, also need to check their HbA1C levels, up to four times a year, to monitor their long-term glycaemic control. Some GPs and specialists may measure this in their practice.
GP, Pharmacy
Urine Creatinine/albumin ratio (ACR)
  • This is a test performed on a urine sample that is used to check kidney function in someone with  diabetes; it can also be performed at point-of-care using the same device as that used for HbA1C testing.
GP, Pharmacy
Lipids
  • Many people are at risk of cardiovascular disease and a large group of people need to take lipid-lowering drugs. In both of these groups, management includes measurement of lipid levels which can be measured in the GP practice.
GP, Pharmacy
C-Reactive Protein
  • This test can be used to help a GP decide whether the acute cough and other related flu-like symptoms a patient may be suffering is due to the more common viral infection or whether it is a bacterial infection.
  • The CRP level can help a GP decide whether someone’s symptoms are possibly due to a bacterial infection and prescribe antibiotics.
GP
Troponin
  • The diagnosis of a heart attack often relies on measurement of troponin. This test is normally performed in the emergency department of a hospital but it can be performed at point-of-care by a GP when it is required in a remote or rural area.  If someone has symptoms of a heart attack in a city or large urban centre, the best advice is to go straight to the ED where they have access to rapid testing.
GP
NT-proBNP
  • This test is used for the diagnosis of heart failure, another common condition. As with troponin, PoCT for NT pro-BNP is used mainly by remote and rural GPs who have limited access to rapid central laboratory testing
GP
Influenza
  • Rapid diagnosis of flu is used by GPs and by some hospital Emergency Departments.
  • As well as speeding up the diagnosis process for a patient with a possible respiratory virus infection there is also value in knowing whether they should be separated or quarantined from other patients.
GP, Hospital Emergency Department
Human Immuno-deficiency Virus (HIV)
  • There are point-of-care testing programs for HIV operating in most states usually in various clinic locations in major cities.
  • Their aim is to provide easier access to HIV testing, particularly to people who might be reluctant to see their GP.
  • Samples that are positive by PoCT are also checked using a laboratory-based test.
HIV Clinics
COVID-19
  • Detection of the virus is used to diagnose corona virus infection
Regional and rural clinics
Blood gases & electrolytes
  • These tests are used to manage adults, children and babies who are critically ill
Hospital critical care units

The photographs shown here are of a selection of point-of-care devices for different tests.
 
PoCT4.jpg
The Cobas 101 device can measure Lipids, HbA1C and urinary albumin/creatinine ratio on a fingerstick sample place. It is used in general practice and outpatient clinics. (Image courtesy of Roche Diagnostics)

 
The Cepheid Gene-Expert device can measure a number of different infection disease viruses including COVD-19. It is being used in Aboriginal Health Clinics and some regional laboratories. (Image courtesy of Cepheid International)
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Last Review Date: June 29, 2020