By Benjamin Ross
April 9, 2019 | Patients rely on the primary care doctor to knowledgably evaluate their symptoms and correctly come to a diagnosis.
But what if the primary care doctor doesn’t have the proper training to make an accurate diagnosis, or the doctor most qualified to make the diagnosis is miles away? This is where point-of-care testing (POCT) comes in, says Gerald Kost.
Kost, Director of the Point-of-Care Testing Center for Teaching and Research (POCT•CTR) and Emeritus Professor in the School of Medicine at University of California, Davis, has spent a good amount of time in Vietnam, starting an educational program and an international collaborative group with Hue University, as well as surveying primary care doctors and hospital staff on needs assessment. When speaking at the Molecular Medicine Tri-Conference in San Francisco, Kost shared the plight primary care doctors in that region face.
It’s impossible to implement POCT in the abstract, Kost said. “We want to work within the context of the network healthcare system that is in this specific country, this specific region, which are all governed by the typology and geography and culture.”
Kost and his team spent over two years in Vietnam, surveying hospital staff within the Thua Thien Hue Province in Central Vietnam about the quality of diagnostic testing in their region. The results of that survey were published in NCBI (DOI: 10.1097/POC.0000000000000167).
“The hard part about Vietnam is you have these great ideas and all these wonderful technologies, but then you have to do it,” Kost said.
The “doing” is limited by the experience of the doctors and the geography of the region, said Kost. He recalled several instances where nurses would pull him aside because the doctors, fresh from med school and conscripted to work for the Vietnam government in a rural area, were not trained to handle the lack of resources. “We need [POCT] because it helps educate the young doctors,” he said.
“Education is fundamental to progress,” Kost and his co-authors wrote in their survey. “Progress is vital for social equity, and social equity is inherent in sustainable POC culture.”
The lack of training results in POCT being used a default technology for diagnostics, Kost said. According to survey results, over 92% of hospitals used POCT to diagnose acute myocardial infarction (AMI), among other diseases.
On the geography end, Kost said that oftentimes qualified doctors would not be within travel distance.
“You’d get to a regional hospital and there would be no interventional cardiologist in the area, so what could you do?” said Kost. POCT enabled doctors to rule in a diagnosis before they would send their patient to another hospital miles away.
“The concept we wanted to introduce was to try to get [POCT] introduced and organized into their emergency medical system so they could diagnose people quicker,” Kost said. The concept, called Spatial Care Paths (SCPs), which help define the most efficient routes for rescuing, diagnosing, and treating patients.
“Transport services, equipment, boats, and vehicles. . .should be improved substantially, and in particular, coordinated SCPs must be designed and implemented so that the time to diagnosis and treatment is less than one hour,” Kost wrote in his survey.
“Instead of having the patient in a rural area move from hospital to hospital to get the care they need, we simply suggest we bypass this by putting [POCT] very close to where the patient is to rule in a diagnosis, and then moving them to a hospital for the proper care,” Kost said.
Kost is currently doing similar analysis in other areas of the world, such as Taiwan and the Philippines, though nothing has been implemented yet. “Though we haven’t tested anything yet, the theory is we could speed up everything in these coastal, linear provinces by placing [POCT] in the right place.”