Infectious diseases can present significant threats to human health and longevity. According to the World Health Organization, as of 2019, "pneumonia and other lower respiratory infections were the deadliest group of communicable diseases."1 And today, the COVID-19 virus continues to infect people in communities across the globe.
Gastrointestinal infections and skin infections can also threaten the health of individuals and spread in communities such as daycare facilities, schools and workplaces. Sexually transmitted infections (STI) require rapid treatment to stop disease progression and community spread.
In-office point-of-care (POC) testing laboratories are an essential tool for preventing the spread of infectious diseases. Examining, diagnosing and treating patients in a single visit helps improve clinical care while reducing disease transmission.
What is POC testing?
POC testing is a broad term for laboratory tests done in a healthcare setting during a patient visit. The most common POC tests include rapid strep, blood glucose monitoring, prothrombin time/international normalized ratio (PT/INR) for people on blood thinners and fecal occult blood.2 And while testing capabilities — and the healthcare settings in which these tests are offered — vary, POC testing in an office setting gives healthcare providers the information they need to make timely clinical decisions.
"POC testing at our office is the most convenient option to provide our patients with instant results," says Brandon Propst, clinical manager at Valley Urgent Care & Occupational Medicine LLC, in Harrisonburg, VA. During some appointments, the practice providers are able to tell patients if they are positive for certain infectious diseases and, when appropriate, immediately instruct patients to go home, rest and start treatment.
Valley Urgent Care collects specimens for send-out tests to local laboratories for some conditions. But the facility also offers some rapid results POC testing, such as rapid COVID-19 tests, flu tests and strep tests.
Confirming diagnostic test results during an office visit, advising patients to isolate and beginning treatment right away go a long way toward helping to prevent the spread of infectious diseases. Without rapid results, some patients may be more likely to resume their normal activities while they wait for lab results, increasing opportunities to spread illness to others.
"POC testing at our office is the most convenient option to provide our patients with instant results." — Brandon Propst
What is community transmission?
Infectious diseases develop from organisms like bacteria, fungi, parasites and viruses.3 In some cases, an infected person may pass a pathogen to another person. While the original source of infection may remain unknown, as more people pass the pathogen to others, more individuals can become infected.
In many cases, POC test results give providers immediate information to diagnose their patients as well as an opportunity to educate patients about infection control measures such as hygiene and quarantining.
Vincent M. Chiodo, M.D., president of ABC Pediatrics in Dunn, NC, believes POC testing drives informed care conversations with parents before a sick child leaves his office.
"If one member of the family presents to our office with a sore throat and I can do an in-office test and confirm it is a streptococcal infection during that visit, this will allow me to have a direct conversation regarding contagiousness to other family members and friends, treatment options, comfort measures and anticipatory guidance for what to expect over the next few days. I can speak confidently to the situation and not speak 'hypothetically.' I can offer specific antibiotic treatment options that can be initiated immediately to decrease household transmission and minimize further spread within schools, sports teams and the community," he says.
Dr. Chiodo's practice offers rapid polymerase chain reaction (PCR) testing for COVID-19. If test results are negative, the doctor can instruct parents to stay alert for any symptoms in their child. But if a test is positive, he can give guidance on quarantining, what they need to do to protect other family members and when they are safe to return within the community. "Not having to send tests out to a reference lab helps us have that discussion with parents and start the treatment plan immediately," he says.
How can the spread of infectious diseases be reduced?
Rapid diagnosis plays a critical role in helping to reduce the spread of infectious diseases. Without conclusive results, patients could transmit diseases to others before they know they are contagious. Routine in-office testing helps identify infections even when patients are asymptomatic. When physicians use in-office testing as part of routine wellness protocols, they could reduce the spread of a condition that would otherwise have gone unnoticed and untreated.
For example, Valley Urgent Care is located near several universities. Traditionally, rates of sexually transmitted infections (STI) are likely to be higher among college-aged students. "Most of the time, our providers do symptomatic testing, but they also do routine wellness testing," Propst says, adding that the practice does not offer in-office lab results for STIs such as chlamydia or gonorrhea. In those cases, specimens are collected and sent out to a reference lab.
"Patient education is huge in these scenarios," Propst says. "Our providers offer patients information about practicing safe sex and notifying partners as soon as test results are available."
In-office POC testing could allow clinicians to detect disease early and begin same-day treatment. According to Ryan Ellenburg, director, advanced product sales at McKesson Medical-Surgical, adding a Clinical Laboratory Improvement Amendments (CLIA)-waived, point-of-care molecular testing platform (such as binx), in office, can enable healthcare providers to have these conversations much sooner.
How POC testing helps control the spread of infectious diseases
POC testing provides immediate results for patients. Those infected can get access to rapid treatment and take steps to protect others from becoming infected. Immediate test results also provide peace of mind for patients who aren't infected.
But proper POC testing requires equipment, staff and the ability to analyze results, Dr. Chiodo says.
"There's a lot that goes into it," he adds, noting that his practice employs two certified medical laboratory technicians and one lab assistant. "As a former medical technologist, I enjoy being able to use that training to educate patients and their families to what the numbers on a CBC (complete blood count) mean and how they relate to treatment plans."
Dr. Chiodo's POC lab is a moderately complex lab — accredited by COLA — that meets federal CLIA requirements.4,5 His equipment includes two Coulter complete blood counters, one Alera® clinical chemistry system, which allows his team to do a panel of twenty blood analytes, a Siemens Clinitek Urine analyzer and five Cephied® Xpert® Xpress instruments, which provide rapid on-site, on-demand detection and differentiation between SARS-CoV-2, flu A, flu B and RSV infections. The practice also uses kits to test for:
- COVID-19 antibodies
- Human immunodeficiency virus (HIV)
- Strep (rapid and cultures)
According to Dr. Chiodo, any tests that can't be done in the office are sent to a local reference lab.
What practices need to know about POC testing
POC testing can help practices improve both the level of clinical care they provide to patients and the patient experience. A literature review published in the June 2021 issue of PharmacoEconomics noted that rapid test results can mean timely treatment decisions, reduced risk of infections and decreased hospitalizations.6
Being able to accurately diagnose, treat and make a plan of care not only helps the patient, but our community by preventing the spread of infection, adds Dr. Chiodo. "Providing anticipatory guidance for strep (a bacterial disease) vs. mono (a viral disease) will also bring comfort to the patient and their family as opposed to waiting and worrying if results are not available for a few days."
Using these improved POC testing platforms can help increase patient referrals and new patients. As the general population learns more about testing options, they become informed healthcare consumers and may seek out providers who can offer the convenience and peace of mind that comes with in-office test results.
Dr. Chiodo notes that POC testing helps streamline care and improve convenience for patients. He also believes that diagnostic certainty is critical to framing care conversations with parents of the children he sees in his practice.
"I can give them anticipatory guidance about what to expect from the virus or bacteria," he says. "And I can say that if anything changes, we'll recheck it. That's the beauty of having some of those tests available when you have the patient in the room."
While Dr. Chiodo's practice has offered POC testing for many years, practices new to in-office labs may face some challenges. Not all POC tests are cost effective when considering payer reimbursements for these tests.
"Our McKesson representative has been invaluable during our purchase of laboratory instrumentation. They brought knowledge of available instrumentation, reagents, input from other users of similar equipment and a cost analysis/potential ROI breakdown for us to review." — Vincent M. Chiodo
"Many in-office kit tests are priced economically so they pay for themselves with third party payor reimbursements," shares Dr. Chiodo. "They might even allow for a slight income to the practice to help offset other procedures that are not reimbursed as well. It's important for healthcare providers to review the volume of bloodwork they send out for lab results as part of the cost/benefit analysis to upgrade their testing platforms. Our McKesson representative has been invaluable during our purchase of laboratory instrumentation. They brought knowledge of available instrumentation, reagents, input from other users of similar equipment and a cost analysis/potential ROI breakdown for us to review."
Dr. Chiodo stands by the value of POC testing as one of the best ways to control the spread of infectious diseases.
"I think we've become spoiled because it's always been with us," he says. "You build up a local reputation for offering in-office testing results and you're able to provide an added service to patients."
In this age of immediate access, immediate response and immediate feedback, in-office laboratory testing is also a great differentiator.
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