Point of Care Labs and Impact

When your muscles feel weak, your body tired and your head dizzy, it can be hard to find the energy and strength to go see a doctor. Now imagine you have no access to transportation, no phone and it’s bitterly cold outside. Seeing a medical professional can seem almost impossible.

Safety net clinics around the country continually see patients facing these odds. But for many of these patients, making it into the clinic does not guarantee an immediate solution to their health problems. If their medical practitioner needs laboratory test to confirm a diagnosis, and they are sent to an outside laboratory, the patient is forced to leave the clinic and then wait days for the results.

That was the situation for one patient, “Steve,” at the Downtown Clinic in Laramie, Wyoming. When the results from his ordered hemoglobin and hematocrit tests for suspected anemia came back days later, clinic personnel realized that Steve’s hemoglobin level was, in fact, critically low. Low hemoglobin levels can be a symptom of potentially life-threatening conditions, and the clinic staff knew they needed to start treatment immediately for Steve.

They tried every means they had available but could not find him. Finally, desperate, the clinic staff called the local police and fire department to help locate him. With the emergency personnel’s assistance, they were able to find and transport Steve to the local hospital to begin immediate treatment. If Steve hadn’t been found, he could have developed a life-threatening condition.

But now, for the Laramie, Wyoming, clinic, the diagnoses delays, time spent searching for patients, and use of extraordinary resources are a thing of the past.

Last year, Downtown Clinic was awarded one of three Point of Care (POC), Enhancing Clinical Effectiveness Grants offered through funds provided by Becton Dickinson (BD). Through these grants, clinics receive equipment, reagents, supplies, training and technical support from Heart to Heart International staff and volunteers for all tests. The grants allow the clinics to select from the following test menu, depending on their patient population: pregnancy, Strep A, HIV, mono, hemoglobin A1C, basic metabolic profile, PT/INR, macroscopic urinalysis, microalbumin, influenza A & B, RSV and lipid profile.

“Large numbers of patients seen at free clinics have chronic diseases that can and should be tracked with laboratory testing,” says Judy Hastert, HHI Manager of Laboratory Programs. “Through the support provided by our partners at BD and NAFC, HHI’s laboratory experts will support the safety net clinic through the setup process and the first year of operation of the point-of-care laboratory. This program identifies the best of what free and charitable clinics are currently doing to address the burden of chronic disease care and allows them to use POC testing to measure progress to patient outcomes and guide evidence-based treatment.”

Within minutes of opening the Downtown Clinic’s POC laboratory, the staff witnessed an example of why the grant project is so important. A regular clinic patient with diabetes came in for an appointment. “Bob” explained that his home blood glucose readings had been “pretty good.” The doctor ordered lab work and the results were obtained within minutes. These results painted a very different picture. Bob’s glucose was at a dangerously high level and had also been uncontrolled for at least the last three months. Because staff was able to run the test in the clinic and talk to the patient right away, his medication regimen was changed and he was referred for nutritional counseling.

Currently, HHI and BD have three clinics around the country using these grants for point of care laboratories in their clinics: Laramie, Wyoming; Rocky Mount, Virginia; Monroe, North Carolina. These clinics were announced as the winners of the grants in 2016 and the laboratories were installed in mid-2017.

These clinics are primarily located in economically disadvantaged areas where housing can be temporary, communication is difficult and transportation is unreliable, leading to incredibly difficult follow-up for patients. If a clinic does not have laboratory capabilities on site, a medical provider must send the materials to an outside laboratory, which will perform the test and relay the results back to the clinic days later. It is the onus of the clinic to relay this information to the patient. But if the patient doesn’t have an address, doesn’t own a phone and has no transportation to return to the clinic, follow-up is frequently difficult, sometimes impossible. Having lab capabilities on site makes the follow-up immediate, increasing compliance and possibly saving lives.

The impact of these labs on site has been immediate and positive. Patients who would’ve had to wait days for test results now can be seen, tested, and prescribed an appropriate treatment based on those test results in one single visit.

Buoyed by the success of the first three clinics, Heart to Heart International has partnered with BD again and is gearing up for its 2nd year of grants to provide POC laboratories to safety net clinics around the country.

“Throughout the U.S., more than 2 million medically underserved people receive health care at one of 1,400 Free and Charitable Clinics,” Nicole Lamoureux, National Association of Free & Charitable Clinics President and CEO, said. “The NAFC is grateful to work with BD and HHI to support clinics who continue to provide high-quality care while operating with limited resources. This program will allow grantees the ability to enhance their on-site diagnostic capabilities and, in turn, expedite the diagnosis of chronic diseases, monitor treatment protocols and improve health outcomes for their patients.”

These six clinics were awarded the grants will receive the instruments, reagents, and training in 2018:

• Ubi Caritas – Beaumont, TX
• HealthFinders Collaborative, Inc. – Faribault, MN
• Hope Health Clinic – LaGrange, KY
• St. Vincent de Paul Medical & Dental Clinic – Phoenix, AZ
• Goochland Free Clinic and Family Services – Goochland, VA
• Clinic with a Heart – Lincoln, NE