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Report

Point-of-Care Testing in Veterinary Medicine

Kim Futrell, MT(ASCP), MSHI

Point-of-Care, Veterinary

Executive summary

With more than 70% of people in the United States as pet owners, annual spending on veterinary care is more than $34 billion.1 Similar to healthcare for humans, veterinary care is experiencing a shift to a more value-based model. In veterinary value-based care, there is a particular focus on end-of-life care and owner preferences.

Laboratory testing for veterinary medicine encompasses large and small animals, as well as diagnostic and research testing. Veterinary laboratory testing takes place in clinics, hospitals, universities, and research facilities. And, while different from human laboratory testing, veterinary laboratory testing involves all the same elements for the best patient care—patient assessment, diagnosis, treatment planning, and follow-up. Laboratory testing includes diagnostic services for all animal species, including necropsy, bacteriology, clinical chemistry, serology, endocrinology, histopathology, immunohistochemistry, virology, parasitology, molecular diagnostics, genetic testing, and toxicology.

Many veterinary clinics perform basic laboratory tests in-house and refer more complex testing to larger veterinary referral laboratories. Veterinarians have long used point-of-care testing (POCT) for diagnostic purposes because of its convenience and timeliness of results. Advances in the development of molecular POCT are expected to greatly contribute to veterinary diagnostics and contribute to improved antibiotic stewardship. In order to manage POCT across locations, veterinary labs can benefit from a POCT data management solution.

Key takeaways

  • Veterinary laboratory testing takes place in clinics, hospitals, universities, and research facilities and involves patient assessment, diagnosis, treatment planning, and follow-up.
  • Veterinarians have long used POCT for diagnostic purposes because of its convenience and timeliness of results.
  • Lateral flow POCT devices are commonly used because they are easy to use and cost effective.
  • Advances molecular POCT development are expected to greatly contribute to veterinary diagnostics.
  • There are many similarities to the challenges of POCT in human care versus veterinary care, such as lack of device standardization.
  • To manage POCT across locations, veterinary labs can benefit from a POCT data management solution.

POCT in a veterinary setting

POCT refers to any laboratory testing that takes place outside the core laboratory close to the patients, such as at a veterinary clinic. In veterinary medicine, just as for humans, POCT is used for preventative care and diagnostic testing. This type of testing provides results more quickly than send-out lab testing, allowing faster diagnosis and subsequent treatment planning at the time of the veterinary visit.

POCT takes place in clinics, academic veterinary medical centers, remote veterinary medical teams, and in research facilities using small handheld or benchtop analyzers. The most frequent use of POCT is for diseases of companion animals. For example, POCT in the form of SNAP tests (enzyme-linked immunoassay) for heartworm, Lyme disease, Ehrlichia, and Anaplasma are often performed as part of a dog’s annual well-check visit.

Lateral flow POCT

Other than the SNAP test, the most used POCT devices for determining infectious disease status in veterinary care are dipsticks and lateral flow devices (LFDs). These methodologies are widely accepted because they are easy to use and cost effective, and results are relatively accurate. LFD testing is known to have a lower sensitivity, and as such, negative results may be followed up with confirmatory testing. See lists below of common and less common POCT in veterinary care.

Examples of commonly used veterinary POCT
  • Anaplasma
  • Chemistry profile
  • CBC
  • Distemper
  • Ehrlichia
  • Fecal testing
  • Feline immunodeficiency virus (FIV)
  • Feline leukemia (FeLV)
  • Giardia
  • Heartworm
  • Leishmaniasis
  • Lyme disease
  • Parvovirus
  • Urinalysis
Examples of less commonly used veterinary POCT
  • Type A avian influenza (chickens, ducks, turkeys, geese)
  • Salmonella (chickens)
  • Brucella antibodies (milk testing)
  • Detect ovulation in cattle to facilitate artificial insemination
  • Progesterone testing to document estrous cycle or confirm pregnancy (horses)
  • Foal immunoglobulin (IgG)
  • Screening for thyroid disorders, Cushing’s disease, Addison’s disease
  • Pancreatitis markers (cPL, fPL)
  • Inflammatory markers (cCRP, fSAA)

Benefits of POCT in veterinary medicine

POCT results, because of their rapid turnaround time (TAT), accompany the veterinary examination and enable decisions to be made while the pet and owner are in the clinic. This faster TAT can decrease costs associated with delayed or incorrect diagnoses.

Aids in initial diagnosis through rapid results

  • Allows for real-time care
  • Can lead to better well-being for the pet

Reduces cost of care by reaching diagnosis faster

  • Can be profitable
  • Reduced costs for the owner

Allows antibiotic prescription based on results rather than empirical therapy

  • Decreases antibiotic-resistant pathogen emergence
  • Promotes antibiotic stewardship

Opportunity for face-to-face conversations that influence client perceptions

  • Develop client loyalty and value perception
  • Improve perception of how well a clinic cares for their pet
  • Improve understanding of, and compliance with, home care

„POCT allows for quick diagnosis and treatment of the patient. Earlier evaluation allows the veterinarian to treat more quickly and effectively, reducing client expense and increasing success in treatment.“    — Andrew J. Rosenfeld, DVM, Dipl. ABVP2

Antibiotic stewardship

Use of POC molecular testing allows for improved antibiotic stewardship programs that track and encourage the careful use of antibiotics to reduce development of resistant strains. There is an increasing focus in veterinary medicine to reduce the development of antimicrobial-resistant bacteria because antibiotic resistance in veterinary patients can potentially transfer to humans.3

In 2022, the global veterinary POCT diagnostics market was $1.74 billion and is predicted to continue to steadily grow. POCT growth in the veterinary market has three main drivers:

1. Increased spending on pets

2. Technological advancements

3. Greater demand for POC diagnostics4

Factors driving POCT growth in veterinary care

  • Increased willingness of owners to spend money to keep their pets healthy
  • Growing concern of consumers about antibiotics and transmissible diseases in milk, eggs, and meat
  • Widespread public concern over the spread of diseases through populations of wild and domestic animals5

POCT developments in vet care

Looking to the future, molecular diagnostics is becoming more affordable and is expected to continue to gain traction in veterinary medicine. Molecular testing can greatly contribute to veterinary diagnostics, particularly for diagnosing viral and mycoplasma infections.

POC molecular diagnostics

The use of molecular-based POCT is not yet typical but expected to increase, just as molecular testing in humans has gained acceptance. As molecular testing technologies progress specific to veterinary medicine, molecular POCT will likely become more widely accepted and available.

For example, to address the low sensitivity of LFDs, polymerase chain reaction (PCR) testing is beginning to replace antigen LFD tests. PCR is well-established in human laboratories as an effective methodology to detect pathogens. Its greater sensitivity makes PCR testing an attractive methodology for veterinary diagnostics, particularly as testing becomes more widely available and affordable.6

In addition, molecular testing can vastly improve microbiology testing TAT. A culture and sensitivity typically take three to five days when sent to a referral laboratory. Waiting for the culture and sensitivity results causes antibiotics to be prescribed empirically to address the suspected infection, improve symptoms, and assure the client that their pet has received prompt care.

Conversely, a POC PCR test can reduce TAT to about two hours. Getting results within hours instead of days speeds the diagnosis and removes the pressure to use empirical therapy. Veterinarians can prescribe targeted treatments for known pathogens and have confidence in the efficacy of those treatments.

Furthermore, PCR testing can facilitate the use of appropriate antibiotics by providing insight into causative pathogens and antibiotic resistance, reducing the use of unnecessary higher-tier antibiotics and subsequently improving overall antibiotic stewardship.

POCT challenges in veterinary medicine

There are many similarities to POCT challenges in human care versus veterinary care. For example, lack of device standardization across facility locations can cause confusion and create more work in tracking reference ranges and maintaining devices. When implementing a POCT device, it is important to carefully consider how it will be used, the testing precision and accuracy, and appropriateness for certain animal types, rather than trying to adapt a human analyzer that may be missing veterinary components.

Just as in human POCT, end user training is extremely important to ensure testing accuracy. For example, the criticality of proper reagent storage and adherence to expiration dates needs to be understood to achieve accurate results.

POCT challenges in veterinary medicine

  • Lack of oversight/overall responsibility for POCT program
  • Lack of device standardization across departments
  • Inadequate research to select best-fit device/methodology
  • Inadequate training
  • Not following manufacturer’s recommendations
  • Device maintenance/software updates not performed
  • QC not performed or tracked
  • Patients not billed h Results not documented in patient chart
  • Missing an LIS/LIMS to track and document testing
  • Lack of inspection criteria — missing quality assurance (QA) initiatives

ASVCP POCT QA recommendations

1. Take a formalized approach to POCT.

2. Develop and use written policies, procedures, forms, and logs.

3. Perform initial operator training and periodic competency assessments.

4. Assess instrument analytical performance, including QC and external QA programs.

5. Establish, validate, and implement appropriate reference intervals.

6. Ensure accurate patient result reporting.

Addressing POCT Quality Assurance: ASVCP Guidelines

While quality assurance is of great importance in veterinary medicine, the veterinary laboratory industry is not as highly regulated regarding inspections. The American Society for Veterinary Clinical Pathology (ASVCP), whose core values include improving animal and human health and maintaining laboratory quality standards, developed QA guidelines for veterinary POCT that are similar to those in human laboratories.7

Improve lab efficiency with vet-focused lab software

While there are similarities to human and veterinary laboratory testing, each has its own challenges as well. For both, early diagnosis plays a vital role in making rapid, critical clinical decisions. In addition, the increase in the prevalence of zoonotic diseases calls for new technologies that provide low-cost rapid test results. Both factors will continue to drive growth of POCT in veterinary medicine.

Many veterinary labs today have a laboratory information management system (LIMS) to manage their testing and provide connectivity to instruments and clients. Having a LIMS that is specifically able to manage animal data can be a big advantage and improve lab efficiency. Labs with a large volume of POCT taking place across locations can benefit from an effective POCT data management system that tracks devices and operator training and provides connectivity.

Clinisys’s veterinary-focused products

Clinisys™ offers a veterinary-focused software solution that provides the benefits of a comprehensive clinical LIMS/LIS designed with the flexibility to support the needs of veterinary laboratories. The solution gives veterinary labs tools to automate manual processes, speed turnaround times, improve efficiencies, and ensure accurate result reporting—supporting the delivery of improved outcomes and high quality of care standards.

Clinisys’s POCT solution, Clinisys™ Orchard® Point-Of-Care™, enables POC coordinators to track patient testing, devices, operator certifications, and QC from a central location to help ensure quality testing and promote patient safety.

Clinisys’s innovative software solutions help veterinary laboratories function efficiently—automating laboratory processes to reduce manual procedures and eliminate paper—positioning their organizations for adaptability, growth, and success.

References

1. 2021-2022 APPA National Pet Owners Survey. Accessed at:  https://www.americanpetproducts.org/ pubs_survey.asp

2. Jergler D. Why veterinarians expect more from diagnostic equipment. Veterinary Practice News. October 2015. Accessed at: www.veterinarypracticenews.com/why-veterinarians-expect-more-fromdiagnostic-equipment/

3. Stewart S. Rapid point-of-care diagnostics in animal hospitals. Innovative Veterinary Care. January 2021. Accessed at: https://ivcjournal.com/rapid-point-of-care-diagnostics-in-animal-hospitals/

4. Grand View Research. Veterinary Point Of Care Diagnostics Market Size, Share & Trends Analysis Report By Product, By Animal Type, By Sample Type, By Indication, By Testing Category, By End-Use, By Region, And Segment Forecasts, 2023 – 2030. Accessed at: https://www.grandviewresearch.com/industryanalysis/veterinary-point-of-care-diagnostics-market-report

5. Cummins, B, Ligler F, Walker G. Point-of-care diagnostics for niche applications. Biotechnol Adv. 2016 May-Jun; 34(3): 161–176. doi:10.1016/j.biotechadv.2016.01.005

6. Maurice S. POC Diagnostic Tools Transformation in Veterinary Practice. Accessed at: https://www.biogal. com/blog/point-of-care-diagnostic-tools-transformation-in-veterinary-practice/

7. Flatland B, Freeman K, Vap L, Harr K. ASVCP guidelines: quality assurance for point-of-care testing in veterinary medicine. Vet Clin Pathol. 2013; 42 (4): 405–423. doi:10.1111/vcp.12099. https://pubmed.ncbi.nlm. nih.gov/24320778/ P