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Point-of-Care Testing

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Cautions

Preparing device for testingWhile many point-of-care tests are designed to be relatively simple and low risk to use, they are not error-proof. Individuals using point-of-care tests, even healthcare practitioners, must carefully follow test directions and be familiar with the test system. Some point of care tests, such as those used to adjust doses of medications, have the potential to lead to serious health consequences if not performed properly. Many large hospitals have point-of-care coordination teams to ensure that testing procedures are properly followed.

It's important that the convenience of point-of-care testing does not tempt users to apply them beyond their intended purpose or misinterpret results. For example, glucose meters and point-of-care hemoglobin A1c tests are designed only for monitoring diabetes and should not be used for diagnosis or screening.

You and your healthcare practitioner also need to be cautious when comparing test results from different sources. Just as test results may not be consistent from laboratory to laboratory, they may vary between point-of-care testing techniques, or between laboratory results and point-of-care results.

One major challenge is managing the data generated by point-of-care tests. When tests are performed at the point-of-care, it is important that the results are incorporated into your health record.

Nurse getting instructions on testing deviceIf you are performing point-of-care tests at home, it's best to seek professional guidance. For example, if you are monitoring a medicine like warfarin for anticoagulation, a testing mistake could lead to a blood clot or internal bleeding. That's why it's recommended that you learn to perform the test with professional supervision and have the result verified by a clinician before performing it at home and periodically to ensure consistent technique.

Getting a follow-up diagnosis from a healthcare practitioner is also important if you use home screening tests. For example, the U.S. Food and Drug Administration (FDA) approved HIV testing for home use in 2012. While home tests are less sensitive and home users can make more mistakes than professionals, the FDA thought the benefit of increased HIV testing outweighed the risks.

Home tests and some point-of-care HIV tests used in clinics, for example, detect only HIV antibody and not the HIV antigen, so they may miss some early infections with HIV. All HIV screening tests that are positive should be followed by a second, different antibody test for diagnosis, and should not stand alone to make a diagnosis. Though HIV home tests and point-of-care tests can offer speed, convenience and privacy, it is important for individuals using these tests to seek follow-up care and diagnosis.

While speed is often one of the advantages of point-of-care tests, the results may not be as specific or sensitive as centralized laboratory test results. For example, there are several types of rapid influenza diagnostic tests (RIDTs) available to help differentiate influenza (flu) from other infections with similar symptoms that must be treated differently. Depending on the method, RIDTs may be done in less than 15 minutes in a healthcare practitioner's office or may be sent to a laboratory, with the results available the same day.

But not all RIDTs have the same ability to detect influenza. Some tests can only detect influenza A while others can detect both influenza A and influenza B but not distinguish between the two. Still others can detect and distinguish between influenza A and B but may not detect the latest strain of influenza circulating that year due to antigenic changes in the virus. Moreover, point-of-care flu tests are not designed to identify the subtype of influenza the patient has, i.e. H3N2 or the pandemic H1N1 strain.

Point-of-care tests may also deliver a more limited range of results compared to full laboratory workups. So, following up with a laboratory test will likely be necessary after an initial test at the point of care.

In general, point-of-care tests should be viewed as a valuable tool for medical testing, but not the only tool. Since you benefit most when point-of-care tests and central laboratory tests are coordinated, it's important that point-of-care tests are not used in isolation.

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