Finger Pricks and Fast Results

Point-of-care (POC) testing can significantly increase routine lipid screening of preteen patients, according to findings from a study published in Pediatrics.

At the beginning of the study, testing rates at three pediatric primary care sites in Pennsylvania were between 1% and 10% among preteens aged between 9 and 11 years, despite recommendations from the American Academy of Pediatrics (AAP) that this population receive a dyslipidemia screening. These low rates reflect a national trend.

At the end of the study, overall testing rates increased to about 50% (18%-60%).

“The biggest barrier is actually obtaining the test,” said Ruth Gardner, MD, a pediatrician at Penn State Health, Hershey, Pennsylvania, who led the study. “This age population is not super excited about having blood drawn, and most clinics don’t have a lab in their office, so that requires a separate visit, either down the hall or in a separate building.”

For this reason, many of the orders clinicians place for lipid screening go unfulfilled. Research questioning the value of testing lipids in all ages of preteens may also lead to confusion among physicians about who should be tested.

Gardner and her team tested how well four methods could improve rates during well visits over a 2-year period starting in May 2021. These included provider feedback, POC testing, use of clinical decision support (CDS) tools, and clinician education. Baseline data on testing rates were collected from 2019 to 2021.

The study included 6762 patients, about half of whom (3323) were seen during the baseline period. About one quarter (24.9%) had their visit during the first year of interventions, when only one of the sites offered POC testing. During the intervention period, 941 patients were tested at clinic 1, 84 at clinic 2, and 165 at clinic 3.

For the first year, only one clinic had POC testing in addition to education and CDS. During well visits, nurses administered a finger prick test, and patients were not required to fast beforehand. Testing rates jumped from 6.4% at baseline to 51.7% at the end of the study, after Gardner and her team asked for feedback from participating clinicians.

The other two sites added the educational and decision support interventions to their daily operations during year 1 of the study, allowing Gardner and her colleagues to use these clinics as a control for POC testing. After the first year, these clinics also added POC testing.

Clinic 2 started at 1.2% at baseline, increasing to 18% in April 2023, and clinic 3 started at 10% and ended at 59% at the end of the study, after providers gained access to POC testing.

Before the researchers brought POC lipid testing to all three sites, 51.2% of screenings happened the same day as the well visit across all clinics. After POC testing became an option, same-day screenings hit 96.3%.

“It’s important for the provider to address it all at once in the context of their well visit,” Gardner said. “When they leave the clinic, they know the results of their lipid test.”

POC testing also allows pediatricians to discuss why a child should be screened.

“Parents who are asked to get lipid screening in their seemingly healthy child just don’t do it. They think, if my kid is healthy, why do I need to get them tested?” said Justin Zachariah, MD, MPH, an associate professor of pediatric cardiology at the Baylor College of Medicine and Texas Children’s Hospital in Houston.

Part of the success of the study is likely due to the fact that clinicians at all three sites were already doing POC testing for measures like lead levels in pediatric patients, which may have helped with provider buy-in.

“Our nurses were already familiar with point-of-care testing, so it didn’t require a different technique,” Gardner said.

Providers received no financial incentive to offer the screening outside of normal reimbursement.

The POC lipid testing machine costs $800-$1400, and each test strip is $10-$15, according to the study authors. Commercial insurance companies typically reimbursed clinics $40-$60 for each test but less for those with Medicaid, Gardner said.

The researchers estimated reimbursements would cover the cost of the device within a couple of months. But Gardner said the initial buy-in can be steep for practices that do not have a large number of patients aged between 9 and 11 years or 17 and 21 years, the recommended ages of testing from the AAP.

For some, time could be another limiting factor, Gardner said. The average time it took to collect and analyze samples was roughly 5 minutes.

“It’s not a tiny finger prick like for diabetes; you have to fill a capillary tube,” she said. “That’s five minutes that a nurse is occupied. For nurses where this is a newer process, it will likely take a bit longer for them to get the process down.”

Despite the cost, Zachariah stressed the importance of adolescent patients receiving a lipid screening before puberty.

“One in five children in the US has high cholesterol. Those children will then go on, in most cases, to be adults with high cholesterol and then develop cardiovascular disease as a result,” he said. “Pediatricians, if they are thinking in a preventative mindset, can help alleviate or reduce the risk of cardiovascular disease very early on.”

The study did not receive outside funding, and the authors do not have any conflicts of interest to disclose.

Kaitlin Sullivan is a journalist living in Colorado.