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Dr Chris Turner explores the evidence around the benefits and impact of near patient testing in primary care. Evidence shows point of care testing (POC) is a cost-effective way to diagnose patients faster than ever, helping empower doctors with the diagnostic confidence to make the best treatment decisions for each patient.
In his landmark Independent Investigation of the National Health Service in England, Prof Lord Darzi highlighted the role that new technologies could play in improving the primary care experience for patients using “local innovations that were improving access and quality of care”.[1]
It has been suggested that implementing point of care (POC) testing in general practice may allow investigations to be performed during a single healthcare visit, reducing repeat attendance and referrals.[2]
In a wide-ranging survey of GP attitudes, respiratory tract infections were identified as a condition which could have diagnosis and monitoring improved by POC testing.[2] There is clearly an unmet need, as primary care doctors would like to use more POC tests.[3]
One area in which there is strong support for testing provision is the rapid diagnosis of respiratory pathogens, including Strep A.[4]
Beyond rapid diagnosis, POC testing can have a range of other benefits in a primary care setting, including time savings for both physicians and patients, optimising management, lowering referrals to secondary care, reducing healthcare costs and improving patient satisfaction.[3]
Despite how common the signs and symptoms of respiratory conditions are in a primary care setting, there are a number of issues that can complicate management.
The underlying diagnosis is often initially unknown for patients presenting to general practice with symptoms of a respiratory infection.[5] Due to the range of possible pathogens, it may not be possible to determine at this stage whether the cause is bacterial or viral in origin.[5]
Achieving a clear diagnosis in general practice for patients with respiratory infections is complex, as relying purely on clinical signs may be inaccurate.[5]
Antimicrobial resistance is a growing issue of global importance.[5]
One of the core strategies to reduce the spread of resistance is to support the appropriate prescription of antibiotics with the development of new diagnostic strategies that aid in clinical decision-making.[5]
In a community setting, one of the most common conditions for which antibiotics are inappropriately prescribed is respiratory tract infections.[5]
Management that is tailored to each patient may be desirable but is not always possible, especially if treatment has to be initiated on the basis of symptoms without the benefit of investigation results.
Many patients with uncomplicated respiratory tract infection still receive antibiotic prescriptions, despite limited evidence that this benefits the patient.[5]
For a new testing pathway to be adopted at local, regional or national level, it will have to show benefits for the patient, the clinical team and the healthcare system. Across diagnosis, clinician confidence and patient satisfaction, there are a number of areas in which point of care testing has been shown to have positive effects.
Each POC testing system has to be evaluated on its own merits. A system with sufficient sensitivity and specificity can generate objective results that meaningfully add to the clinical assessment of primary care physicians.[5]
For tests that have been adopted, the majority of GPs experience positive effects, with 89% feeling that POC testing would improve the safety of their decision making.[4]
One reason doctors may want to have access to results at the time of the patient consultation is to increase their confidence in the diagnosis. This is reflected in GPs’ opinions on POC testing, with nearly 90% feeling that it could increase diagnostic certainty.[5]
In a primary care setting, the fast turnaround of results can eliminate the long intervals between patient examination and a discussion of investigation results.[6] This may contribute to the findings that point of care investigations can reduce unnecessary diagnostic testing and improve the confidence that clinicians have in their management plans.[4],[6]
Point of care testing has the potential to have a positive impact on patient care for respiratory conditions including RSV and influenza by reducing unnecessary diagnostic testing and antibiotic prescriptions.[6] It has been suggested that respiratory point of care testing may come to play a vital role in good antibiotic stewardship.[7]
POC testing can help to revise diagnosis based on clinical symptoms, with testing for respiratory pathogens in one study leading to a change in clinical diagnosis in 20% of cases.[8]
Beyond supporting diagnosis and treatment, using POC testing to aid clinical decisions may have the potential to increase patient satisfaction with the service they receive.[2]
Appropriate use of point of care testing has the potential to offer cost-saving efficiencies by helping improve the accuracy of prescribing, reduce unnecessary referrals in to secondary care, and by helping reduce overall healthcare cost.[4]
A Cochrane review into the use of point of care testing in the management of sore throat provided one clear example.[9] They found that the use of a rapid test for Strep A could reduce antibiotic prescription rates by 25%.[9]
Another potential benefit of having a rapidly delivered quantitative test result is that it may aid patient management when getting advice remotely from another clinician.[4]
The management of respiratory infections in primary care can raise a number of issues for healthcare professionals, including not being able to make a definitive diagnosis and the subsequent treatment choices that this brings.
Point of care testing for respiratory symptoms in primary care has the potential to allow for rapid diagnosis and personalised treatment, helping to reduce inappropriate antibiotic prescription and increase patient satisfaction.
References
1. Independent investigation of the NHS in England. Darzi A. 2024. Available from: https://www.gov.uk/government/publications/independent-investigation-of-the-nhs-in-england Accessed: September 2024.
2. Turner PJ, et al. Family Practice. 2016;33(4):388–394.
3. Schols AMR, et al. British Journal of General Practice. 2018;68(673):362-363.
4. Mills SEE, et al. BJGP Open. 2024;8(2):BJGPO.2023.0094.
5. Cooke J, et al. BMJ Open Resp Res. 2015;2:e000086.
6. Lingervelder D, et al. Int J Clin Pract. 2019;73:e13392.
7. Thornton HV, et al. British Journal of General Practice. 2020;70(701):574-575.
8. Khalid TY, et al. Fam Pract. 2021;38(5):598-605.
9. Cohen JF, et al. Cochrane Database of Systematic Reviews. 2020;6:CD012431.
