Point of care (POC) is bogged down because of ineffective biohazard containment, insufficient environmental robustness, test clusters-cartridges unable to target rapidly emerging diseases, unpredictable errors in bedside results, dependence on misleading global parametric rather than local nonparametric statistical analysis, high marginal costs cited without assessing overall value, inadequately funded POC research, regulatory-industry intransigence, dichotomous introduction of new instruments abroad versus the United States, and meager interest in critical global challenges. The objective is to push back on these classic signs of an interrupted paradigm shift. They threaten the future of the field, this journal, and the ultimate goal, to improve medical and economic outcomes.
We offer a geospatial method, Spatial Care Paths™ (SCPs), by which a portion of the future of POC can be reinvigorated interactively in cultural context.
The Ebola epidemic revealed serious gaps in technology and swiftly changed expectations. Expectations are part of culture. Hence, the future paradigm must embrace POC culture. We provide paradigm-refreshing conceptual examples ranging from national disaster caches to diabetes care to outbreaks. We use visual logistics to illustrate the concepts and SCPs.
By identifying weak links in the chain of community resilience, SCPs upscale key unfulfilled needs, discover new ideas for innovation-invention, bolster educational outreach, and improve patient access to evidence-based primary, emergency, and hospital care. Strong collaborative initiatives can foster activism in the global community. It is time for insightful leadership and participative outreach to bridge professional disciplines, span different countries, and steward POC into a brilliant new future.
From the *Point-of-Care Center for Teaching and Research (POCT•CTR), School of Medicine, UC Davis; †Knowledge Optimization®, Davis, CA; and ‡College of Population Studies, Chulalongkorn University, Bangkok, Thailand.
Reprints: Gerald J. Kost, MD, PhD, MS, FACB, Point-of-Care Testing Center for Teaching and Research (POCT•CTR), School of Medicine, 506 Citadel Dr, University of California, Davis, CA 95616. E-mail: email@example.com.
This study was supported by the Point-of-Care Testing Center for Teaching and Research (POCT•CTR) and by the Edward W. and Ora I. Kost Foundation.
The authors declare no conflict of interest.
Disclaimer: Devices must comply with jurisdictional regulations in specific countries, operator use limitations based on patient conditions (eg, the critically ill), federal and state legal statutes, and hospital accreditation requirements. Not all point-of-care devices discussed in this article are Food and Drug Administration approved for use; the US Food and Drug Administration emergency use authorizations for Ebola molecular diagnostics, summarized in reference 5 (Kost GJ, Ferguson WJ, Hoe J, et al. The Ebola Spatial Care Path:™ Accelerating Point-of-Care Diagnosis, Decision Making, and Community Resilience in Outbreaks. Am J Disaster Med. 2015;10:121–143), are limited in scope and term. Please check with manufacturers for the current status of molecular diagnostics and point-of-care tests within the relevant domain of use.