Family Medicine may have been pioneering, but silently the Pediatrics has followed this direction, which is summarized in an internationally adopted term: Point of care Test o POCT, which can be translated as “medical analysis performed in close proximity to the site of patient care and treatment.” In practical terms, several outpatient methods are now available that can provide a rapid and sufficiently reliable answer to diagnostic questions. After all, already some mothers have become familiar with urine sticks, blood glucose strips and, in recent times, salivary tests for Covid-19. What is new, widely reiterated at recent national conferences, is that family pediatricians are now agreed and prepared to make this momentous leap. This is not a duty imposed on them, but an initiative through which everyone can improve their quality of care.
The advantages
Being able to perform an investigation at the same time as an examination offers several possibilities: for example, it can confirm the nature of an infection and consequently direct treatment, or it can bring valuable information where a child is unable to describe his or her symptoms or the clinical picture itself is confusing. Still, it can clarify a doubt when faced with an unexpected finding, such as a heart murmur, or assess the progress of a chronic disease such as bronchial asthma. These interesting aspects are then complemented by other advantages, such as the absence or reduction of the waiting time required to perform a test in a hospital or specialist center and the reduction in costs due to both possible travel and the savings that many times correlate with the earliness of a diagnosis and consequently treatment.
What examinations
Technology offers a really wide range, from chemical tests on blood, saliva, and urine to instrumental investigations, for example, dermoscopy for the evaluation of skin lesions and particularly moles, electrocardiogram, spirometry, and impedance testing. Tests, such as allergy or hearing tests, and even ultrasound and refractometry (for diagnosis of amblyopia, the so-called “lazy eye”) can then be performed. In short, there is no limit to the potential for development, for which many devices are already integrated with the computer or smartphone and allow images to be stored and sent in real time, both to the parents and to any second-tier centers to which the child should be sent.
Security and reliability
While some tests are easy to perform, others require specific training of the pediatrician, who is responsible for the choice of instrumentation, which, in some cases, also requires a financial investment. Generally speaking, however, it should be said that these are first-tier tests, that is, investigations that are a good compromise in order to confirm or not confirm a given suspicion. The goal, in fact, is to identify cases worthy of further investigation and at the same time to be sufficiently sure of any negative outcome. This opens a new era in which the pediatrician-and by extension the parents-will be able to count on the valuable support of tests and equipment that can speed up diagnosis, avoiding unnecessary and sometimes harmful waste of time, saving families and the health service money.
