The Coronavirus Disease 2019 Spatial Care Path: Home, Community, and Emergency Diagnostic Portals

Kost, Gerald J.

doi:10.3390/diagnostics12051216

Cited by 13 publications

(10 citation statements)

References 104 publications

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“…Sea ambulances have an ambulance stretcher, automated external defibrillator (AED), suction machine, nebulizer, aneroid sphygmomanometer, stethoscope, oxygen cylinder, and examining light. Testing for COVID-19 must wait until patients arrive at larger healthcare sites, such as Rural Health Units that perform rapid antigen tests (RAgTs) and the District Hospital, which offers RAgTs and RT-PCR assays, the latter capable of both ruling in and ruling out SARS-CoV-2 infection as prevalence increases [ 8 ].…”

Section: Resultsmentioning

confidence: 99%

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Using geographic rescue time contours, point-of-care strategies, and spatial care paths to prepare island communities for global warming, rising oceans, and weather disasters

Kost,

Füzéry,

Caratao

et al. 2023

Int J Health Geogr

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Objectives To perform geographic contour analysis of sea and land ambulance rescue times in an archipelago subject to super typhoons; to design point-of-care testing strategies for medical emergencies and weather disasters made more intense by global warming and rising oceans; and to assess needs for prehospital testing on spatial care paths that accelerate decision making, increase efficiency, improve outcomes, and enhance standards of care in island nations. Methods We performed needs assessments, inspected healthcare facilities, and collected ambulance rescue times from professionals in the Bantayan Archipelago, Philippines. We mapped sea/land ambulance rescue routes and time contours. To reveal gaps, we statistically compared the fastest and slowest patient rescue times from islands/islets and barangays to the District Hospital on Bantayan Island. We developed spatial care paths (the fastest routes to care) for acute myocardial infarction, community care, and infectious diseases. We generated a compendium of prehospital diagnostic testing and integrated outcomes evidence, diagnostic needs, and public health goals to recommend point-of-care strategies that build geographic health resilience. Results We observed limited access to COVID-19 assays, absence of blood gas/pH testing for critical care support, and spatial gaps in land and airborne rescues that worsened during inclement weather and sea swells. Mean paired differences (slowest-fastest) in ambulance rescue times to the District Hospital for both islands and barangays were significant (P < 0.0001). Spatial care path analysis showed where point-of-care cardiac troponin testing should be implemented for expedited care of acute myocardial infarction. Geospatial strengths comprised distributed primary care that can be facilitated by point-of-care testing, logical interisland transfers for which decision making and triage could be accelerated with onboard diagnostics, and healthcare networks amenable to medical advances in prehospital testing that accelerate treatment. Conclusions Point-of-care testing should be positioned upstream close to homes and island populations that have prolonged rescue time contours. Geospatially optimized point-of-need diagnostics and distributed prehospital testing have high potential to improve outcomes. These improvements will potentially decrease disparities in mortality among archipelago versus urban dwellers, help improve island public health, and enhance resilience for increasingly adverse and frequent climate change weather disasters that impact vulnerable coastal areas. [350 words].

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Section: Resultsmentioning

confidence: 99%

“…Point-of-care testing is medical testing at or near the site of patient care [ 7 ]. A diagnostic portal is the geographic entry point from home to hospital where the patient self-tests or first seeks, obtains, or is administered diagnostic testing to rule in or rule out a medical condition and then expeditiously receives care [ 8 ].…”

Section: Methodsmentioning

confidence: 99%

Using geographic rescue time contours, point-of-care strategies, and spatial care paths to prepare island communities for global warming, rising oceans, and weather disasters

Kost,

Füzéry,

Caratao

et al. 2023

Int J Health Geogr

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“…Point-of-care testing programs can be designed and implemented in rural and remote areas to educate and train healthcare staff on the use of RAgTs for infectious diseases [ 68 ]. Test clusters can be selected for types of disasters [ 69 , 70 ].…”

Section: Discussionmentioning

confidence: 99%

Optimizing Public Health Preparedness for Highly Infectious Diseases in Central Vietnam

Zadran

et al. 2022

Diagnostics

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Our primary objectives were (a) to determine the need for and the availability of point-of-care testing (POCT) for infectious diseases and (b) to recommend point-of-care testing strategies and Spatial Care PathsTM (SCPs) that enhance public health preparedness in the regional districts of Thua Thien Hue Province (TTHP), Central Vietnam, where we conducted field surveys. Medical professionals in seven community health centers (CHCs), seven district hospitals (DHs) and one provincial hospital (PH) participated. Survey questions (English and Vietnamese) determined the status of diagnostic testing capabilities for infectious diseases and other acute medical challenges in TTHP. Infectious disease testing was limited: six of seven CHCs (86%) lacked infectious disease tests. One CHC (14%, 1/7) had two forms of diagnostic tests available for the detection of malaria. All CHCs lacked adequate microbiology laboratories. District hospitals had few diagnostic tests for infectious diseases (tuberculosis and syphilis), blood culture (29%, 2/7), and pathogen culture (57%, 4/7) available. The PH had broader diagnostic testing capabilities but lacked preparedness for highly infectious disease threats (e.g., Ebola, MERS-CoV, SARS, Zika, and monkeypox). All sites reported having COVID-19 rapid antigen tests; COVID-19 RT-PCR tests were limited to higher-tier hospitals. We conclude that infectious disease diagnostic testing should be improved and POC tests must be supplied near patients’ homes and in primary care settings for the early detection of infected individuals and the mitigation of the spread of new COVID-19 variants and other highly infectious diseases.

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“…Point-of-care testing programs can be designed and implemented in rural and remote areas to educate and train healthcare staff on the use of RAgTs for infectious diseases [67]. Test clusters can be selected for types of disasters [68,69].…”

Section: Diagnostic Test Criteria and Placementmentioning

confidence: 99%

Optimizing Public Health Preparedness for Highly Infectious Diseases in Central Vietnam

Zadran¹,

Ho²,

Zadran³

et al. 2022

Preprint

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Our primary objectives were a) to determine the need for, and the availability of point-of-care testing (POCT) for infectious diseases and b) to recommend point-of-care testing strategies and spatial care paths (SCPs) that enhance public health preparedness in regional districts of Thua Thien Hue Province (TTHP), Central Vietnam, where we conducted field surveys. Medical professionals in 7 community health centers (CHCs), 7 district hospitals (DHs) and 1 provincial hospital (PH) participated. Survey questions (English and Vietnamese) determined the status of diagnostic testing capabilities for infectious diseases and other acute medical challenges in TTHP. Infectious disease testing was limited: 6 of 7 CHCs (86%) lacked infectious disease tests. One CHC (14%, 1/7) had two forms of diagnostic tests available for the detection of Malaria. All CHCs lacked adequate microbiology laboratories. District hospitals had few diagnostic tests for infectious diseases (Tuberculosis, Syphilis), blood culture (29%, 2/7), and pathogen culture (57%, 4/7) available. The PH had broader diagnostic testing capabilities but lacked preparedness for highly infectious disease threats (e.g., Ebola, MERS-CoV, SARS, Zika, and Monkeypox). All sites reported having COVID-19 rapid antigen tests; COVID-19 RT-PCR tests were limited to higher tier hospitals. We conclude that infectious disease diagnostic testing should be improved and POC tests must be supplied near patients’ homes and in primary care settings for the early detection of infected individuals and mitigation of the spread of new COVID-19 variants and other highly infectious diseases.

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The Coronavirus Disease 2019 Spatial Care Path: Home, Community, and Emergency Diagnostic Portals

Cited by 13 publications

References 104 publications

Using geographic rescue time contours, point-of-care strategies, and spatial care paths to prepare island communities for global warming, rising oceans, and weather disasters

Using geographic rescue time contours, point-of-care strategies, and spatial care paths to prepare island communities for global warming, rising oceans, and weather disasters

Optimizing Public Health Preparedness for Highly Infectious Diseases in Central Vietnam

Optimizing Public Health Preparedness for Highly Infectious Diseases in Central Vietnam

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