For many years now investigative diagnostic testing has established itself as a basic essential service that healthcare professionals need for them to be able to deliver the expert clinical advice and care to patients at both centralised hospital locations and in the wider community at large.
These testing services have traditionally been established in pathology laboratories quite often located on hospital sites but also in other commercial situations such as privately-operated laboratories.
With the dramatic rise in the scope and complexity of what testing laboratories can offer and the increasing demands of the population that the healthcare community serves together with the almost exponential rise in service costs, some years ago it was recognised that to continue to deliver testing services centrally was going to be an ever increasing challenge.
This recognition has led to the establishment of numerous initiatives so that where practical and possible centralised testing has been moved away from the laboratory and performed in outpatient clinics, primary healthcare centres and doctor’s surgeries. The so-called ‘Point of Care’ age was born.
Here we review the benefits of each approach to testing. Paul Bates, Sales Manager at Hart Bio said: “Point of Care testing (POCT) refers to any testing that is performed near-to or at the location of the patient.
“Laboratory testing on the other hand is any testing that is performed away from a patient at an external laboratory site.
“POCT has the benefit that because the testing devices used are designed to correlate with laboratory systems and procedures they can be used quickly and reliably to assess patient needs locally without the need for the patient to make that expensive trip to hospital. In some situation these devices can be used to self-test.
“Testing generally involves the patient providing a small sample of blood or urine for use in the POCT device. If follow-up testing is required, then that might be done centrally but, in the context, and knowledge of the POCT result.”
Hart Biologicals has a significant interest in POCT with its Thrombistat MC1, a testing solution designed to measure a patient’s INR, a critical parameter used to control anticoagulation therapy.
Paul went on to say: “Our tried and tested Thrombistat MC1 allows a patient INR determination to be carried out quickly and efficiently in around two minutes next to the patient.
“Used in conjunction with software that provides quick analysis of results adjustments to a patient’s dose of the blood thinning agent Warfarin can be made there and then removing the need for any follow-up contact with the service unit afterwards and very importantly increasing the security of maintaining the patient in the require therapeutic range where the drug provides its maximal anticoagulation protection”
Hart Biologicals has also recently introduced its new Fiix Test which is designed to simplify the process of determining a patients INR for medical professionals.
Paul commented: “Not all INR measurements are carried out in the community. Some of the more difficult to manage patients can find themselves being monitored by central laboratories for a variety of reasons, this can be due to genetic effects, lifestyle issues or other underlying medical conditions and medications being used.”
The Fiix test is designed for laboratory use. By using an additive to the testing reagent, the test offers patients a stabilized anticoagulation effect, improved clinical outcome and reduced anticoagulation variability meaning longer times between testing are needed.
Paul emphasised: “Fiix is an example of where the lab test is probably better than the POCT, we have high hopes for this product”
There are other medical conditions where POCT has not fully developed the capability to be used in the primary healthcare situation and diagnostic testing is still carried out in the laboratory.
Disorders of platelet function or genetic conditions like Glanzman’s or von Willebrand disease mean that detailed investigations have to be carried out, which only laboratories can perform.
Paul said: “Investigations of platelet disorders is still mainly in the domain of the laboratories because the investigation can follow a multi-level route to get to a definitive diagnosis.
“The other consideration for the patient is that the sample has a relatively short timeframe during which it can be tested meaning samples cannot be taken and sent in from outside locations and patients generally have to attend specific clinics at the laboratory”
“All is not lost though when testing for platelet defects. Systems are being developed and established which can be used outside the laboratory for looking at platelet performance particularly around measuring the effectiveness of the use of anti-platelet drugs.
“Looking to the future and using our expertise at Hart Biologicals we expect to be part of this initiative in the coming years as we build upon and apply our current levels of knowledge to developing systems of the future”
When it comes to weighing up the benefits of each form of testing it’s important to understand thatPOCT and laboratory testing each have their advantages and benefits and quite often work in tandem to provide the complete care package that patients require.
Hart Biologicals provides a number of products that help in determining and monitoring levels of a variety of blood coagulation factors. For more information on our products click here or contact Paul on: Paul.Bates@hartbio.co.uk