Point-of-Care Testing Challenges

Despite the possibilities point-of-care testing (POCT) offers, there are many challenges that exist. For instance, the settings where POCT occurs include nursing homes, hospitals, and clinics. In these locations, testing is considered a laboratory test. Some of these laboratories have the ability to apply for a Certificate of Compliance, Certificate of Accreditation, or a Certificate of Waiver. These laboratories undergo a two-year cycle of checkups and are required to pay attention to quality, competency, and directorship. However, the large number of laboratories that have gained accreditation has resulted in a lack of sufficient checkups due to limited resources needed to inspect all of them.

The increased pressure on physicians to see patients or admit them to an emergency room indicates that quick results are needed rapidly. Unfortunately, faster does not equate to better “if the result’s timeliness has little or no impact on the outcome of care,” according to Ncmedicaljournal.com. There has been little to no proof (shown in the form of studies) that when tests are performed at a POCT location, patient outcomes improve. In fact, 25% to 40% of laboratory tests are deemed useless and unnecessary. This underscores the importance of having warrants placed to ensure effective testing for patient management.

The fact that many tests can be done but few impact patient outcomes stems from the lack of evidence that POCT impacts primary care pathways. POCT can only be used to its fullest extent if POC testing is based on primary care rather than secondary care. As of now, most POC testing is done based on diagnostics rather than clinical needs and focuses more on secondary care instead of primary care. However, the actual impact of POC in primary care remains unstable.

Cost is also an issue to consider. As POC is yet to be developed further, testing machines present the largest barrier due to their cost. Maintenance and future development costs were highlighted in various responses in a free-text section according to bjgpopen.com. Furthermore, quality assurance presents itself as something to contemplate. Individuals who are not laboratory-trained can misunderstand the importance of quality assurance and control for POC devices. When adding POCT to a clinical setting, the workload for the staff increases due to the need for running maintenance steps and quality control testing, which can occur on a daily basis. Pre-analytical errors were found to be at a higher rate than most laboratory testing, which can be associated with positive patient identification.

Other challenges presented by POCT include connectivity and location issues. POCT connectivity relates to the challenge of having to manually enter test results, which permits errors. This is due to the decentralization of POCT, meaning only a small portion of results are automatically integrated electronically. A data management solution must be put in place for POCT results to reach their full potential.

References:

North Carolina Medical Journal [Internet]. ncmedicaljournal.com. Available from: https://ncmedicaljournal.com 

Mills SE, Akbar SB, Hernandez-Santiago V. Barriers, enablers, benefits, and drawbacks to point-of-care testing: a survey of the general practice out-of-hours service in Scotland. BJGP Open [Internet]. 2024 Apr 3; Available from: https://bjgpopen.org/content/early/2024/03/29/BJGPO.2023.0094#:~:text=Barriers%20to%20POC%20test%20use 

Top 4 Point-of-Care Testing (POCT) Challenges: Connectivity, Locations, Devices, & Operators [Internet]. Orchard Software. Available from: https://www.orchardsoft.com/blog/top-4-point-of-care-testing-poct-challenges-connectivity-locations-devices-operators/ 

Shaw JLV. Practical challenges related to point of care testing. Practical Laboratory Medicine. 2016 Apr;4:22–9. 

[Infographic] Recent Poll Reveals Major Challenges Point-of-Care Coordinators Experience [Internet]. Orchard Software. [cited 2024 Jul 25]. Available from: https://www.orchardsoft.com/blog/infographic-recent-poll-reveals-major-challenges-point-of-care-coordinators-experience/ 

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