Implementing in-vitro diagnostic point-of-care tests in community health care: how can we make this work?

In-vitro diagnostic point-of-care tests (POCTs) are performed across a broad range of sample types, with professional and self-administered POCTs gaining widespread familiarity during the SARS-CoV-2 pandemic. POCTs can rapidly inform clinical decisions, with potential benefits including the optimisation of disease management and referrals, reduction in healthcare costs, increased patient satisfaction, and better treatment adherence. Surveys have identified POCTs that GPs believed could be helpful and conditions where they considered that POCTs, if available, could support clinical decision making.¹,² Community-based health care is responsible for high volumes of activity (the majority of NHS contacts),³ dealing with largely undifferentiated patient populations, incorporating a high proportion of conditions that need minimal intervention or are self-limiting, but also low-prevalence, potentially serious conditions that require prompt, appropriate management. Community health care plays a fundamental role in disease prevention and the management of long-term conditions. Implementation of POCTs in UK community health care does not currently align with the desire for POCTs reported previously.¹,² Evaluating evidence quality for the use of POCTs is crucial to support implementation decision making. While clinical performance is commonly studied, areas such as clinical effectiveness, cost-effectiveness, and broader impact are less frequently evaluated.⁴ A systematic review of implementation of 83 POCTs showed that clinical utility was of paramount importance for GPs, yet was rarely assessed.⁵ Limited community implementation of POCTs may be partly attributable to a lack of understanding of the elements required to achieve success. These include: GPs’ concerns about clinical utility; access to laboratory and diagnostic technology expertise; provision of funding, training, and support models; sound implementation strategies; and evidence-based monitoring.⁶,⁷