Point-of-care technologies in heart, lung, blood and sleep disorders from the Center for Advancing Point-of-Care Technologies

2021 Patient Preferences for Point of Care Testing Survey: More Acceptance and Less Concern

BACKGROUND

The evolving opinions of our community members provide insights into how end-users perceive the value and identify key point-of-care test (POCT) characteristics.

METHODS

We deployed our validated 45-item English-language survey to uncompensated volunteers and compared the results from 1264 respondents in 2021 with those obtained in 2020.

RESULTS

Average responses for items regarding the benefits of POCTs demonstrated that the 2021 respondents indicated agreement with all 14 potential benefits. Average responses for items regarding concerns were distinctly different from those for benefits. The only concern item that scored in the agree range was "not having insurance coverage for POCTs." Average responses to the other 13 concern items were in the disagree range. For 8 of these items, the magnitude of disagreement was greater in the 2021 survey than was observed for the 2020 survey. Differences in POCT exposure over time and by US regions suggest that higher levels of exposure to POCTs in the East are associated with stronger public support.

CONCLUSIONS

Community members strongly support the development of accurate, convenient, easy-to-use, affordable, equitably available, in-home POCTs that produce immediate results. This empowers patients and home caregivers to diagnose, manage, enhance their adherence to medical treatments, and more efficiently engage their physicians.

Understanding Healthcare Professionals’ Perspectives on Point-of-Care Testing

Point-of-care testing (POCT) is an emerging technology that provides crucial assistance in delivering healthcare. The COVID-19 pandemic led to the accelerated importance of POCT technology due to its in-home accessibility. While POCT use and implementation has increased, little research has been published about how healthcare professionals perceive these technologies. The objective of our study was to examine the current perspectives of healthcare professionals towards POCT. We surveyed healthcare professionals to quantify perceptions of POCT usage, adoption, benefits, and concerns between October 2020 and November 2020. Questions regarding POCT perception were assessed on a 5-point Likert Scale. We received a total of 287 survey responses. Of the respondents, 53.7% were male, 66.6% were white, and 30.7% have been in practice for over 20 years. We found that the most supported benefit was POCTs ability to improve patient management (92%) and that the most supported concern was that POCTs lead to over-testing (30%). This study provides a better understanding of healthcare workers’ perspectives on POCT. To improve patient outcomes through the usage of POCT, greater research is needed to assess the needs and concerns of industry and healthcare stakeholders.

COVID-19: a gray swan's impact on the adoption of novel medical technologies

The COVID-19 pandemic offers a unique context and opportunity to investigate changes in healthcare professional perceptions towards the adoption of novel medical technologies, such as point-of-care technologies (POCTs). POCTs are a nascent technology that has experienced rapid growth as a result of COVID-19 due to their ability to increase healthcare accessibility via near-patient delivery, including at-home. We surveyed healthcare professionals before and during COVID-19 to explore whether the pandemic altered their perceptions about the usefulness of POCTs. Our network analysis method provided a structure for understanding this changing phenomenon. We uncovered that POCTs are not only useful for diagnosing COVID-19, but healthcare professionals also perceive them as increasingly important for diagnosing other diseases, such as cardiovascular, endocrine, respiratory, and metabolic diseases. Healthcare professionals also viewed POCTs as facilitating the humanization of epidemiology by improving disease management/monitoring and strengthening the clinician-patient relationship. As the accuracy and integration of these technologies into mainstream healthcare delivery improves, hurdles to their adoption dissipate, thereby encouraging healthcare professionals to rely upon them more frequently to diagnose, manage, and monitor diseases. The technological advances made in POCTs during COVID-19, combined with shifting positive perceptions of their utility by healthcare professionals, may better prepare us for the next pandemic.

Point-of-care testing, your cardiologist, and affairs of the heart

Background

Point-of-care testing (POCT) has applications across medical specialties and holds promise to improve patient care. While cardiovascular medicine has been attractive for POCT applications in recent years, little is known about how cardiovascular health professionals perceive them.

Objective

The objective of our study was to examine differences in perceptions and attitudes towards POCTs between cardiovascular health professionals compared to other healthcare professionals.

Methods

We surveyed healthcare professionals to assess perceptions of POCT usage and their benefits and concerns between October 2019 and March 2020. Questions regarding POCT perceptions were assessed on a 5-point Likert scale.

Results

We received a total of 148 survey responses; of the responders, 52% were male, 59% were physicians, and 50% worked in a hospital setting. We found that cardiology professionals were less likely, compared to other specialties, to view POCTs as improving patient management or reducing errors. These cardiology professionals were not constrained by resources or a lack of investment opportunities to implement these technologies.

Conclusion

This study provides a better understanding of perceptions about POCTs among healthcare specialists. To improve patient outcomes through the adoption and usage of POCTs, greater collaboration is advised among key industry and healthcare stakeholders.

Patient Preferences for Point-of-Care Testing: Survey Validation and Results

Background

Studies of current opinion of our community members for the characteristics, mode, and location of use, use cases, and overall enthusiasm for point-of-care testing (POCT) diagnosis and management tools are needed.

Study Design and Methods

Qualitative research methods were used to develop, refine, and evaluate hardcopy and electronic versions of a 45-item English language survey. The accuracy of the instrument was measured by recorded structured interview, and its precision was measured by comparison to its administration to a group of uncompensated volunteers.

Main Findings and Results

Comparison of survey and structured interview data demonstrated high levels of accuracy. Highly concordant with significant levels of correlation and of direct association indicated favorable precision. Ninety-three percent of respondents believed that POCT could improve their care, and 56% identified having a POCT in their home as a top priority. Accuracy, insurance coverage, immediacy of results, and ease of use were identified as the most important characteristics of a POCT.

Conclusions

Community members strongly support the development of accurate, in-home devices that produce immediate results that can be used to diagnose, manage, and encourage their adherence to treatments for their medical conditions.

The RADx Tech Clinical Studies Core: A Model for Academic Based Clinical Studies

The National Institutes of Health (NIH) launched the Rapid Acceleration of Diagnostics (RADx^SM) Tech initiative to support the development and commercialization of novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) point-of-care test devices. The primary objective of the Clinical Studies Core (CSC) was to perform SARS-CoV-2 device studies involving diverse populations and settings. Within a few months, the infrastructure for clinical studies was developed, including a master protocol, digital study platform, data management system, single IRB, and multi-site partnerships. Data from some studies are being used to support Emergency Use Authorization of novel SARS-CoV-2 test devices. The CSC reduced the typical time and cost of developing medical devices and highlighted the impactful role of academic and NIH partnership in addressing public health needs at a rapid pace during a global pandemic. The structure, deployment, and lessons learned from this experience are widely applicable to future in vitro diagnostic device clinical studies.

Development and Test of a Portable ECG Device with Dry Capacitive Electrodes and Driven Right Leg Circuit

The use of wearable sensors for health monitoring is rapidly growing. Over the past decade, wearable technology has gained much attention from the tech industry for commercial reasons and the interest of researchers and clinicians for reasons related to its potential benefit on patients' health. Wearable devices use advanced and specialized sensors able to monitor not only activity parameters, such as heart rate or step count, but also physiological parameters, such as heart electrical activity or blood pressure. Electrocardiogram (ECG) monitoring is becoming one of the most attractive health-related features of modern smartwatches, and, because cardiovascular disease (CVD) is one of the leading causes of death globally, the use of a smartwatch to monitor patients could greatly impact the disease outcomes on health care systems. Commercial wearable devices are able to record just single-lead ECG using a couple of metallic contact dry electrodes. This kind of measurement can be used only for arrhythmia diagnosis. For the diagnosis of other cardiac disorders, additional ECG leads are required. In this study, we characterized an electronic interface to be used with multiple contactless capacitive electrodes in order to develop a wearable ECG device able to perform several lead measurements. We verified the ability of the electronic interface to amplify differential biopotentials and to reject common-mode signals produced by electromagnetic interference (EMI). We developed a portable device based on the studied electronic interface that represents a prototype system for further developments. We evaluated the performances of the developed device. The signal-to-noise ratio of the output signal is favorable, and all the features needed for a clinical evaluation (P waves, QRS complexes and T waves) are clearly readable.

SLOCK (sensor for circadian clock): passive sweat-based chronobiology tracker

SLOCK is a human sweat based platform for circadian relevant biomarkers- cortisol and DHEA. It monitors passively expressed eccrine and apocrine sweat towards measuring and reporting cortisol and DHEA concentrations over multiple time points in humans. The sensor works on the principle of affinity based electrochemical detection. The novelty lies in the usage of a hybrid porosity platform for enhancing multibiomarker detection ability through sweat. The platform is the first demonstration of chronobiology tracking using multiple biomarkers supported by human subject based study. The sensor performance is evaluated on a set of six healthy human subjects, which are varied by age, gender, and ethnicity. Following this, the sensor performance is confirmed using ELISA, a commercially used diagnostic technique. From the results, it can be observed that the sensor is highly sensitive to the target biomarker concentrations in the physiological range of 8-141 ng ml^-1. The platform is also able to capture the biomarker rise and fall (i.e., going from a low concentration of 1 ng ml^-1 to a high concentration of 100 ng ml^-1 and back down to 10 ng ml^-1). This is reflected by a percentage change of cumulative sensor response by 10%, 20%, and 22%, respectively from baseline, for cortisol. Similarly for DHEA, the sensor shows sensitivity to rising and falling changes with percentage changes of 45%, 55%, and 56% for 1, 100, and 10 ng ml^-1 biomarker concentrations. This sensitivity is crucial in order to develop the circadian profile for the user. Thus, the sensor offers a first time demonstration of the potential of a passive self-monitoring approach for managing circadian abnormalities and is a good platform for tracking chronobiology.