In my experience, pathologists’ views on POCT can vary significantly, from extremely proactive to potentially disruptive. Having said that, more pathologists are coming on board with POCT and understand that it is better to work with and support users rather than to ignore them. In fact, our POCT task force not only consists of clinical scientists and industry representatives, but it is represented by clinical pathologists too.
There is a vast array of POCT equipment available. And because the end user may not be a scientist, the decision on what piece of equipment best suits their needs is often a difficult one. So there is a real need for guidance on selecting equipment suitable for clinical intent. Users need to be encouraged to think about local resources and conditions to ensure the equipment they use will work efficiently in their environment.
Our current key focus is developing education and providing assistance to underdeveloped countries starting out on their POCT journey or wanting to improve the current POCT service. To anyone who regards POCT as a threat to more traditional laboratory testing, I would remind them that pathology tests are performed for the benefit of the patient. In many rural and remote areas around the world there are no labs available, so basic tests, such as electrolytes, hemoglobin, INR and blood gases, or tests for an acute presentation, are difficult to perform, if they are performed at all! There are also concerns for those who require regular pathology testing and need to leave their family support network behind to get it. In each of these scenarios, POCT is invaluable.
As with all pathology tests, pathologists have an important role in the education and support of POCT. Ideally, doctors who require assistance with interpretation of a POCT will have the opportunity to contact their local laboratory service or a pathologist for assistance. Pathologists will also be involved in determining analytical requirements of tests. It is up to the scientific community, including pathologists, to drive improvements in the quality of POCT by working with industry and setting quality goals for future development.
We are currently involved in developing educational materials on different aspects of POCT, including a quality framework, appropriate clinical use, connectivity, and cost-effectiveness. Integration of POCT into routine clinical care of the patient is also important in cases where the laboratory can either not provide timely results, or is not available. In particular, quality testing for POCT – that is to say, making sure POCT operators understand the importance of running internal and external quality control and how often – is a particularly significant issue and one that we are addressing with our educational efforts. One of our main challenges is reaching out to other professions performing POCT. Increased use of POCT in pharmacies has prompted a lot of discussion with IFCC members concerned internationally that pharmacies are not subjected to the same quality demands as laboratories. Our challenge will be to work with pharmacists and other groups running POCT to ensure that any pathology tests performed outside of the laboratory are run within a quality framework.
What we would now like to do is to grow a communication network that is inclusive of all groups – expert individuals in IFCC, other expert groups, regulatory agencies, and users of POCT. This specialist network will assist individuals who want to implement POCT or improve their current service by providing appropriate education that ensures quality service. This effort constitutes a major goal for our task force. Whatever pathologists or scientists may think of POCT, isn’t it better to be involved and influence the process positively rather than to sit back and see performance of pathology tests deteriorate? POCT is here to stay, so we all need to work together to ensure it is performed in a quality framework so that patient care is not compromised.
Rosy Tirimacco is network operations and research manager at Integrated Cardiovascular Clinical Network (iCCnet), Australia, and chair of the IFCC task force on POCT.
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