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The need for a quicker test result is one of the key aims of PoCT and this can deliver benefits for healthcare consumers and healthcare providers.
Let us start with the example of a patient who is seriously ill and being managed in a critical care unit. They may be so sick that they need to be ventilated, which requires the levels of oxygen and carbon dioxide in their blood to be measured frequently. This can only be done effectively using point-of-care testing through blood-gas instruments. These provide oxygen and carbon dioxide results in minutes after taking blood samples from the patient. The rapidly produced results can then be used to adjust the patient’s ventilation system very quickly and as such, are a vital part of critical care medicine.
Historically, one of the factors that drove the development of PoCT instruments half a century ago or more ago was the pioneering use of ventilators to manage patients with polio in the epidemics of the 1950s. The company that developed these early point-of-care instruments is still a leading manufacturer of them today.
One of the first point-of-care devices used to measure blood gases on critically ill patients in the 1950s. (Image courtesy of Radiometer Pty Ltd)
PoCT is not only helpful for the acutely ill but also for those with chronic diseases such as diabetes. Glucose meters have revolutionised care for diabetics who can now monitor their glucose without even needing to take blood samples – this might be seen as the ultimate in point-of-care testing.
People with diabetes also need to measure their HbA1C levels as well as their glucose levels, but less often – maybe up to four times a year. Having an HbA1C test requires a diabetic to visit a pathology collection centre to have their blood taken. The sample is then sent to the laboratory, which following analysis, sends the result to the patient’s doctor. The patient then goes to their GP or specialist to discuss the HbA1C result and possible changes to their treatment. For the patient this essentially means two trips every time their HbA1C result is measured and reviewed.
Figure 3 shows this process and also identifies where the process can occasionally go wrong when the doctor does not have a recent HbA1C result to discuss with the patient; this makes the consultation less effective.
HbA1C testing can now be measured on small point-of-care devices in doctors’ practices and a few GPs and specialists around Australia are routinely performing PoCT for HbA1C on their diabetic patients. This means one visit combines the collection (Figure 3). As well as the obvious convenience for the patient, the PoCT process avoids some of the potential problems that lead to an HbA1C result not being available at the time of the consultation.
Accurate and reliable PoCT for HbA1C has been available for some years and many trials have been conducted around the world including Australia, which have compared the PoCT process to central laboratory testing. Some of the evidence from these trials indicates that PoCT can be beneficial.
The role of PoCT is perhaps more important for consumers and patients who live in the country where access to pathology testing is not as easy and convenient as in cities or major regional centres. Testing is critically important for those with chronic health problems and regular testing such as HbA1C, together with clinical check-ups, is important in keeping people healthy and out of hospital.
In South Australia, the Integrated Cardiovascular Clinical Network (ICCNetSA) runs a dedicated PoCT program for both acute diagnosis and chronic disease monitoring program in conjunction with country GPs. This video, provided courtesy of ICCNetSA, explains what it means for the patients, the GP and the community:
Last Review Date: June 29, 2020