From hospital care to community: accelerating diagnostics and treatment through POCT

Over the past decade, there has been a global trend toward decentralisation in healthcare, particularly in rural areas, low-income areas, and developing world regions [1]. Decentralised healthcare shifts authority away from a central power and toward areas closer to health service users. Point-of-care testing (POCT), or testing at or near the patient’s bedside, is useful in decentralised healthcare models, with benefits including increased access for patients living outside large city centres, rapid bedside results allowing faster diagnostic decisions, and decreased lag time between patient presentation and treatment.

One example of a world region trending toward a decentralised healthcare model is India. The country’s resources are unevenly distributed. Although large city centres feature advanced hospitals with central labs, people in rural regions (who account for the majority of India’s 1.4 billion residents [2]) have limited access to these resources. POCT can bridge this gap, providing people in more remote areas with portable tools that enable rapid diagnosis at the site of patient care. Improved early disease detection can accelerate treatment, improve monitoring, and improve referrals, which in turn can reduce hospitalisations and lengths-of-stay, along with healthcare costs.

Technology advancement in POCT space: Microfluidics

Microfluidics technology, which emerged in the 1980s, processes small amounts of fluid (on the microlitre scale) through tiny pressurised channels. Uses for this technology span multiple industries, ranging from inkjet and 3D printing to pharmacology studies and water quality testing. In POCT, microfluidics is used in single-test devices (e.g., COVID-19 tests) as well as “lab-on-a-chip” devices that can perform multiple laboratory functions using a single fluid sample. Advantages of microfluidics-based systems include the ability to process microlitre-scale fluids, precise fluid control for rapid multiplex testing, and reduced dependence on multiple POCT systems. According to a March 2025 paper published in Discover Chemistry [3], microfluidics-based POCT systems hold considerable promise for diagnostic applications in low-resource settings. Portable microfluidic devices can significantly increase early disease diagnosis in underserved regions with limited access to central labs [3]. The COVID-19 pandemic accelerated adoption of POCT, highlighting the critical importance of rapid, sensitive virus detection in driving disease management, particularly in emergency care settings.

POCT usage in hospital care

POCT has long been a staple in critical care hospital settings such as emergency departments (EDs) and intensive care units (ICUs), where rapid diagnosis and early treatment are crucial to positive patient outcomes. Patients in critical care settings often present with undifferentiated symptoms such as chest pain, fever, and shortness of breath; obtaining a quick, accurate diagnosis is critical for guiding timely intervention in these cases. Selected applications for POCT in these settings include analysis of cardiac, inflammatory, and haematologic biomarkers; these are described in more detail below.

Cardiac biomarkers

Cardiac biomarkers analysed using POCT include troponin T and N-terminal pro B-type natriuretic peptide (NT-proBNP). In the randomised ARTICA trial, researchers concluded that using troponin T POCT in pre-hospital settings to identify low-risk patients and rule out non-ST-segment elevation acute coronary syndrome reduced 30-day healthcare costs with a low incidence of major adverse cardiac events. As the troponin T POCT may be performed in pre-hospital and non-hospital settings, it can reduce unnecessary ED visits; benefits of this include decreased costs as well as minimised patient transport and associated discomfort [4].

The POC-HF pilot trial studied whether serial point-of-care NT-proBNP measurements influenced treatment decisions for patients with acute decompensated heart failure. Researchers concluded that the measurements may be associated with faster up-titration of medication, more pronounced NT-proBNP decrease, and faster recovery compared to symptom-guided therapy [5].

Inflammatory biomarkers

Inflammatory biomarkers that may be measured with POCT technology include C-reactive protein (CRP) and procalcitonin (PCT). As elevated CRP levels may indicate serious infection and other inflammatory conditions, taking multiple CRP measurements at the patient’s bedside via POCT provides a critical, timely means of determining whether the patient’s health is improving with treatment. As PCT levels rarely increase in response to viral infections, a bedside PCT test is useful in determining an infection’s origin and helping to avoid unnecessary antibiotic use. This is particularly important as bacterial drug resistance rises worldwide. The timely results provided by POCT enable providers to begin appropriate treatment quickly. As some point-of-care PCT tests provide results as semi-quantitative number ranges, the tests may be particularly valuable when quantitative measurements are unavailable within a short time frame [6].

At a POCT expert panel in Mumbai this April, Dr Kedar Toraskar, Director of Critical Care at Wockhardt Hospitals, presented the case of a 66-year-old man with prior myocardial infarction and reduced left ventribular ejection fraction (LVEF) with acute chest heaviness, dyspnea, hypotension, and hypoxia. Clinical findings suggested mixed cardiogenic and septic shock. A point-of-care ultrasound (POCUS) revealed pneumonia and pulmonary edema, while an ECG showing anterior ST depression provided the necessary evidence of acute cardiac strain. Combined with markedly elevated CRP levels, these findings indicated a dual pathology of sepsis-induced acute coronary syndrome . The diagnosis was confirmed when the patient required proximal LAD stenting via angioplasty in addition to sepsis management. The use of POCT aids in the early diagnosis of sepsis, even before culture reports were available from the central lab. The affordability and rapid nature of the CRP test also enabled Dr Kedar Toraskar and his Asia Pacific experts’practice to engage in ongoing daily monitoring to establish a response trend and guide timely antibiotic de-escalation. The patient in this case study underwent intra-aortic balloon pump placement and angioplasty, and was able to discontinue antibiotics in a timely manner supported by CRP trends showing clinical improvement. The combination of POCT and POCUS was highly valuable for evaluating undifferentiated shock and hypoxemia, enabling rapid and precise bedside clinical decision-making [7].

Haematologic biomarkers

Haematologic biomarkers that may be measured using POCT include hemoglobin and prothrombin (with results given as an international normalised ratio or PT-INR). In certain world regions, low hemoglobin levels are a major health concern. In India, maternal anemia is a leading cause of adverse fetal and neonatal outcomes. The prevalence of anemia in India varies widely across age, region, and gender. For example, the prevalence of anemia in men in India is approximately 25%, compared to 57% in women and 67% in children between the ages of six months and five years [8]. Benefits of POCT for anemia include capillary blood use (expanding application to include healthcare settings without phlebotomy or lab staff), rapid results (enabling same-day treatment commencement), and device portability (with handheld, battery-powered analysers operating in rural and low-infrastructure settings) [9]. These benefits bring diagnostics closer to underserved populations and reduce loss to follow-up.

POCT usage in decentralised care

Although POCT has traditionally been popular in hospital critical care settings, the technology’s value has gained wide appeal in other settings including home healthcare, alternate site care, remote regions, low-income regions, and regions with strong adoption of decentralised healthcare. In addition, the COVID-19 pandemic spurred interest in telehealth and rapid testing outside hospital settings. This system has benefits to healthcare systems, healthcare providers, and the public. Decentralisation allows healthcare systems to respond to rising healthcare costs with cost-effective methods for managing care, focus on vital services, and implement standardised training programmes for its users. For providers, decentralisation enables patient-centred care, shorter hospital lengths-of-stay, and focus on specialised services. Patient satisfaction is foundational to decentralised care, driving increased accommodation of patient needs and improvements in service delivery [1].

A key way of meeting patient needs is providing access to health services in remote and underfunded regions; POCT can be a critical tool in not only expanding the reach of diagnosis and treatment, but doing so in a timely manner that can significantly accelerate time to treatment. In addition, India’s healthcare landscape includes a substantial percentage of out-of-pocket expenditures (accounting for nearly half of total health expenditures) [10]. The concentration of specialised services in city centres leaves rural populations with reduced access, often compelling them to take on the additional expenses of travel and accommodation [11]. POCT can alleviate these additional costs as well as enabling faster treatment times, driving adoption of point-of-care technology.

In heavily populated world regions with a high adoption of decentralised healthcare, such as India, the use of POCT to enable early diagnosis and intervention has the potential to significantly impact the management of chronic diseases such as diabetes. According to the International Diabetes Federation, the 2024 prevalence of diabetes in India was 89.8 million among adults ages 20–79 years (a 10.5% age-standardised prevalence); by 2050 this is expected to increase to 156.7 million [12]. Early diagnosis and intervention could have a significant impact on disease burden in regions like India; POCT has the capacity to bring diagnostic capabilities to remote regions with limited access to centralised testing resources [3]. The technology also has the capacity to quickly differentiate between diseases, providing patients with rapid reliable results and quicker treatment times; see case study below.

Diabetes case study

At the previously mentioned expert panel on POCT therapies, Dr Vishal Chopra, Founder of Dr Vishal Chopra Diabetes and Thyroid Care, highlighted the case of a 54-year-old man with shortness of breath, disorientation, raised jugular venous pressure, and suspected obstructive sleep apnea. The patient’s history included diagnoses for type 2 diabetes, hypertension, hypothyroidism, and obesity. Traditional testing for diabetes patients includes glucose and HbA1c testing; however, the multiple assays available in POCT systems enabled clinicians to test for multiple parameters including CRP and NT-proBNP. The NT-proBNP level was elevated, indicating cardiac complications, while the high CRP level pointed toward an underlying inflammatory or infectious process. The patient was diagnosed with heart failure with preserved LVEF and acute kidney injury secondary to urinary tract infection. This complicated presentation and history of diabetes could have caused a delay in identifying cardiac disease, but use of POCT enabled early diagnosis and intervention, likely preventing a critical event [13].

Expert insights

While experts stress the need for validation of lab test results by trained professionals such as pathologists and microbiologists, the assessment of POCT systems is positive, with benefits apparent in many hospital and non-hospital settings. A clinical utility benefit associated with POCT is that the technology enables rapid, evidence-based decisions in time-critical clinical pathways or in remote and resource-limited settings where access to centralised laboratory infrastructure is restricted. A major operational benefit of POCT is the rapid turnaround time, crucial in emergency scenarios such as sepsis and myocardial infarction. In decentralised settings, a key benefit of POCT is reduced patient waiting times and the ability to capture patients for follow-up and treatment while they are on site; this particularly applies to the screening or diagnosis of chronic conditions such as diabetes. In addition, patients with urgent conditions who present in the primary care setting may be assessed using POCT, empowering primary care providers to make accurate triage decisions for patients (treating them on site or sending them to hospital for further intervention).

Conclusion

POCT provides a portable, versatile technology for rapidly diagnosing disease and enabling timely intervention, with the potential for significantly improving patient outcomes. This is particularly true in regions where access to advanced hospitals with diagnostic labs may be limited; however, even in large hospital settings, POCT can provide quicker turnaround times than central labs in most cases, which can lead to timelier treatment. As decentralised healthcare becomes more popular globally, POCT will remain a critical tool for improving healthcare access, with multiple use cases across hospitals, clinics, and community settings. The continued evolution of technology and expansion of available assays promises to further democratise diagnostics, bringing more tests closer to patients and transforming care delivery.

References

[1] Becker’s Hospital Review (2024) An essential strategy for the future of healthcare: decentralization. Available at: https://www.beckershospitalreview.com/strategy/an-essential-strategy-for-the-future-of-healthcare-decentralization/ (Accessed: 7 September 2025).

[2] Statista (2025) Rural and urban population in India. Available at: https://www.statista.com/statistics/621507/rural-and-urban-population-india/ (Accessed: 30 September 2025).

[3] Das, A. and Prajapati, P. (2025) ‘Navigating pharmaceuticals: microfluidic devices in analytical and formulation sciences’, Discovery Chemistry, 2(49).

[4] Aarts, G.W.A., Camaro, C., Adang, E.M.M., et al. (2024) ‘Pre-hospital rule-out of non-ST-segment elevation acute coronary syndrome by a single troponin: final one-year outcomes of the ARTICA randomised trial’, European Heart Journal – Quality of Care and Clinical Outcomes, 10(5), pp. 411-420.

[5] Boesing, M., Bierreth, F., Abig, K., et al. (2024) ‘Effects of serial NT-proBNP measurements in patients with acute decompensated heart failure: results of the POC-HF trial’, Global Cardiology Science and Practice, (4), e202431.

[6] National Library of Medicine (2023) Point-of-care testing. Available at: https://www.ncbi.nlm.nih.gov/sites/books/NBK539794/ (Accessed: 7 September 2025).

[7] Toraskar, K. (2025) ‘Case Presentation: Mixed Cardiogenic and Septic Shock in a 66-year-old Patient’, LumiraDx™ Think Tank: Real-world Experience Sharing. Courtyard by Marriott, Mumbai, 12 April.

[8] Jeevan, J., Karun, K.M., Puranik, A., et al. (2025) ‘Prevalence of anemia in India: a systematic review, meta-analysis and geospatial analysis’, BMC Public Health, 25, p. 1270.

[9] An, R., Huang, Y., Man, Y., et al. (2022) ‘Emerging point-of-care technologies for anemia detection’, Lab on a Chip, 21(10), pp. 1843-1865.

[10] Kamath, S., Maliyekkal, J., Raj, S.E.A., et al. (2025) ‘Understanding out-of-pocket expenditure in India: a systematic review’, Frontiers in Public Health, 13, 1594542.

[11] Cyr, M.E., Etchin, A.G., Guthrie, B.J., et al. (2019) ‘Access to specialty healthcare in urban versus rural US populations: a systematic literature review’, BMC Health Services Research, 19, p. 974.

[12] International Diabetes Federation (2025) India diabetes report 2025. Available at: https://diabetesatlas.org/data-by-location/country/india/ (Accessed: 7 September 2025).

[13] Chopra, V. (2025) ‘Diabetes Care: In-Clinic Patient Management Case Study’, LumiraDx™ Think Tank: Real-world Experience Sharing. Courtyard by Marriott, Mumbai, 12 April.