Point-of-care testing in India: missed opportunities to realize the true potential of point-of-care testing programs

Abstract

BackgroundThe core objective of any point-of-care (POC) testing program is to ensure that testing will result in an actionable management decision (e.g. referral, confirmatory test, treatment), within the same clinical encounter (e.g. POC continuum). This can but does not have to involve rapid tests. Most studies on POC testing focus on one specific test and disease in a particular healthcare setting. This paper describes the actors, technologies and practices involved in diagnosing major diseases in five Indian settings – the home, community, clinics, peripheral laboratories and hospitals. The aim was to understand how tests are used and fit into the health system and with what implications for the POC continuum.MethodsThe paper reports on a qualitative study including 78 semi-structured interviews and 13 focus group discussions with doctors, nurses, patients, lab technicians, program officers and informal providers, conducted between January and June 2013 in rural and urban Karnataka, South India. Actors, diseases, tests and diagnostic processes were mapped for each of the five settings and analyzed with regard to whether and how POC continuums are being ensured.ResultsSuccessful POC testing hardly occurs in any of the five settings. In hospitals and public clinics, most of the rapid tests are used in laboratories where either the single patient encounter advantage is not realized or the rapidity is compromised. Lab-based testing in a context of manpower and equipment shortages leads to delays. In smaller peripheral laboratories and private clinics with shorter turn-around-times, rapid tests are unavailable or too costly. Here providers find alternative measures to ensure the POC continuum. In the home setting, patients who can afford a test are not/do not feel empowered to use those devices.ConclusionThese results show that there is much diagnostic delay that deters the POC continuum. Existing rapid tests are currently not translated into treatment decisions rapidly or are not available where they could ensure shorter turn-around times, thus undermining their full potential. To ensure the success of POC testing programs, test developers, decision-makers and funders need to account for such ground realities and overcome barriers to POC testing programs.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-015-1223-3) contains supplementary material, which is available to authorized users.

Laboratory validation and field usability assessment of a point-of-care test for serum bilirubin levels in neonates in a tropical setting

“…Therefore, the assertion by the midwives that the device was easy to use, required limited training, and could be mastered in more remote settings is valid. However, the data from the usability assessment support the technical validation: the system proved to be poorly suited for low resource settings 31 . More specific caveats in the use of this system require particular attention.…”

How patients navigate the diagnostic ecosystem in a fragmented health system: a qualitative study from India

“…Study methods have been described in detail elsewhere [2]. In brief, data were collected between January 2013 and June 2013 in Kadugondanahalli (KG halli), one of Bangalore’s 198 administrative units, and Tumkur, a rural district in Karnataka (India).…”

“…Table 1 provides the profile of the respondents of the seven semi-structured interviews. We drew on the material from the rest of the project where necessary [1,2] (an additional 10 FGDs and 71 interviews).…”

“…Depending on a country’s specific diagnostic set-up, patients and providers play different roles in ensuring that correct and timely diagnosis is reached and treatment is initiated. India has a complex, fragmented healthcare delivery system, and in our previous work, we have shown that the onus is usually on the patient to ensure that test and treat cycles or diagnostic processes are completed [1,2]. This follow-up paper traces the diagnostic journeys of patients in South India and examines the work they have to do to arrive at a diagnosis.…”

Bioimpedance analysis vs. DEXA as a screening tool for osteosarcopenia in lean, overweight and obese Caucasian postmenopausal females

“…The goal of the introduction of new POC tests and POC devices is to provide fast, affordable test results to clinicians so that they may make an expedited clinical management decision and hence improve patient outcomes and overall public health. [54][55][56] The BIA-ACC ® device offers an acceptable determination of body composition with a satisfactory variability and with demonstration of a strong concordance with the traditional DEXA reference standard in postmenopausal women. It also provides information about sarcopenia and serves as a safe screening tool for abnormal bone density.…”