Use of Point-of-Care Tests (POCTs) by US Primary Care Physicians

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Figure 1.
The numbers of respondents who use or would use the point-of-care testing ≥1 time a week (black bar) among those reporting current or desired use (full bar). The percentages indicate the proportion of respondents. ALT, alanine aminotransferase; ANA, antinuclear antibody; AST, aspartate aminotransferase; BNP, brain natriuretic peptide; CRP, C-reactive protein; ESR, erythrocyte sedimentation rate; GGT, gamma-glutamyl; hCG, human chorionic gonadotropin; HDL, high-density lipoprotein; INR, international normalized ratio; LDL, low-density lipoprotein; MRSA, methicillin-resistant Staphylococcus aureus; PSA, prostate-specific antigen; TSH, thyrotropin-releasing hormone.

Table 1.

Top 10 Conditions for Which a Point-of Care Test Could Help Make a Diagnosis

Table 2.

Top 10 Conditions for Which a Point-of Care Test Could Help Monitor or Manage

↵* A total of 113 respondents completed question 2; 3 reported that they did not believe that point-of-care tests could help them monitor conditions. However, the percentages are based on N = 110.
↵† Spirometry.
COPD, chronic obstructive pulmonary disease; INR, international normalized ratio; UTI, urinary tract infection.

Table 3.

Conditions for Which a Point-of Care Test Would Help Reduce Referrals for Specialty Care or Hospital Admission

↵* A total of 113 respondents completed question 3; 13 reported that they did not believe that point-of-care tests could help them reduce referrals. However, the percentages are based on N = 100.
† Spirometry.
COPD, chronic obstructive pulmonary disease; INR, international normalized ratio; UTI, urinary tract infection.

Table 4.

Sample Comments about the Potential Impact of Health Care Policy Changes on the Use of Point-of-Care Testing

Response Group	Sample Comments
Believe that policy changes will increase POCT use	“Yes, if there are recommendations to use these tests by established, evidence-based guidelines, they will be used.”
	“Yes, as family medicine becomes more important in the health care arena, we will need more tests to care for the total person and to refer appropriately.”
	“Yes, with patient-centered medical home.”
	“Yes, with more patients eligible for primary care, there will be more problems to diagnose and POCT will be an important tool for the primary care doctors to care for patients efficiently and at lower cost.”
Believe that policy changes will decrease POCT use	“I believe that the government will severely limit what can be done via POCT.”
	“Yes. Less reimbursement or approval. Need for prior authorization.”
	“I think POCT will be more limited due to cost.”
	“Yes, I think that CMS will begin to regulate quality control of these tests.”
Believe that policy changes will have a mixed effect on POCT use	“Yes. We need to be paid for doing the tests to make it worth the time and training hassle. The amount needs to reflect the added patient convenience of not having to do the lab.”

Table 5.

Sample Comments about Benefits of and Concerns about Point-of-Care Testing

Response Group	Sample Comments
Benefits of POCTs	“Quick answers allow immediate feedback to patients.”
	“POCTs are vital to appropriate diagnosis and appropriate management of many commonly treated conditions.”
	“I have had in house lab for years, and it has saved a few lives or reduced significant morbidity. POCT are [sic] the Future.”
	“Judicious use of POCTs in the future means overall healthcare savings.”
	“I believe changing medication doses at the time of visit is much more impactful instead of calling the patient later. Quick diagnosis of UTI, strep throat etc. also allows for appropriate quick treatment.”
Concerns about POCT usage	“Being able to monitor quality/run controls”
	“Concern of accuracy of some of these tests—false negatives and positives.”
	“Payment in a CLIA waived office is really an issue.”
	“Reimbursement [from] insurance inhibits risk to acquire equipment and maintenance needs.”
	“Only concerns would reimbursement from insurance, the initial investment cost, and regulation from the government.”
Both benefits and concerns	“They can be quite useful for patient feedback, but if they are not reliable, they are less helpful.”
	“Concerns over sensitivity and specificity of test results, helpful to be able to diagnose infections earlier, helpful to monitor critical values such as the INR more quickly.”
	“Benefit—fast result, concerns—false negative.”