Table 3 Recommended Patient-focused Diagnostics for Spatial Care Path Acceleration in the Bantayan Archipelago
Medical challenge | Diagnostics | Implementation sites for rapid decision making | Enhanced outcomes |
|---|---|---|---|
Acute abdomen | CBC, enzymes (ALT, AST, lipase), ECG, abdominal UTZ | Rural Health Unit triage diagnostics with progressive plan for District Hospital support of transfer to tertiary care medical facility | Diagnose and stabilize patients with acute abdomen (e.g., appendicitis, pancreatitis,) before transferring to a tertiary medical facility |
Acute myocardial infarction | POC qualitative or semiquantitative cTnI/ cTnT | Ambulance, Barangay Health Station, and Rural Health Unit rule in of AMI | Fast therapeutic turnaround time, earlier triage, bypass time-consuming intermediate processing steps, appropriate and timely therapy (e.g., CABG, PCI), improve survival, and diminish mortality in rural versus urban environments |
Quantitative cTn, hs-cTnI or hs-cTnT | Rural Health Unit, District Hospital, or heart center for both rule-in and rule-out of AMI with Rx in < 30–60 min | ||
COVID-19 | POC RAgT, self-testing, home LAMP tests (free) | Ubiquitous access: vending machines, mobile vehicles (ambulance, health van), Barangay Health Stations, Rural Health Units, pharmacies, and more | Self-testing empowerment, early detection, family and workforce protection, outbreak mitigation, patient education, new public health paradigm, and precedents for the next pandemic |
RT-PCR | Rural Health Unit, District Hospital | ||
Viral load | Academic or reference laboratory | ||
Critical care Support and transport | O2 saturation (pulse oximetry), electrolytes, BG, Ca++, and pH | Sea, land, and air ambulances | Pulmonary and cardiac support, decreased morbidity and mortality |
Rural Health Units, emergency rooms | |||
Glucose, lactate PT (INR), D-dimer | Prehospital transport and ambulance services | Risk stratification, spotting critical patients, triage to intensive care, hemostasis Rx, PE management | |
Prediabetes, diabetes diagnosis, and therapeutic monitoring | HbA1c near homes every three months | Rotating POC HbA1c instruments in community sites during physician rapid Dx and Rx on site | Earlier Dx of prediabetes and diabetes, improved control of patients under Rx |
Critical care test clusters selected from the POC tests above | Ambulances for immediate detection of hypoglycemia and hyperglycemia | Risk mitigation using onsite Dx of diabetic ketoacidosis, hyper-glycemic hyperosmotic coma, and other glucose hemostasis problems | |
“Hidden” medical problems | POC ultrasound | Sea, land, and air ambulances, primary care network, ER/EDs, and Barangay Health Stations in the surrounding islets and islands | Numerous applications for triage, acute care, intubation, and orthopedics |
Infectious diseases | POC STI (STD), Dengue, EVD, Monkeypox, and other rapid tests | All points of need depending on deadly outbreaks and community prevalence of sexually transmitted diseases (e.g., Monkeypox) | Rapid Dx, decreased opportunity costs, improved infant welfare, earlier start of isolation, and decreased time to Rx |
Non-life-threatening acute conditions | O2 saturation, electrolytes, glucose, BUN, Cr, BNP (or NT-proBNP), portable ECG | Paramedic outreach to the patient home, community center, and Barangay Health Station | On site Dx, triage, and Rx of CHF and COPD exacerbations, dehydration, UTI, and other acute conditions in or near homes to spare EMS resources, avoid overload of ERs, and allow faster response for more pressing cases |
Obstetric emergencies | CBC, glucose, ECG, pelvic UTZ, CTG | Coordinated strategy by Barangay Health Station, Rural Health Unit, and District Hospital to supply fetal heart monitoring along with basic POC tests already available on site | Decrease infant and maternal mortality resulting from obstetric complications (e.g., prolonged labor, placenta previa, and uterine atony) |
Sepsis and septic shock | Test clusters drawn from suitable instruments (e.g., Cobas h232, HemoCue, i-Stat, StatStrip, CoaguChek, and Pocket-chem) | Land ambulance for rescue with on scene victim evaluation by means of a kit of POCT handheld instruments | Change in conveyance decisions, minimized rescue time, recognition of critical medical problems requiring admission and Rx, economic benefits, enhanced survival and lower morbidity and mortality |
Molecular diagnostics | District Hospital rapid molecular detection of pathogens (handheld and portable molecular diagnostics) | ||
Snake bite | PT (INR), aPTT, Hct/Hgb | Barangay Health Stations (depending on local prevalence of snake bites in the primary care network) | Rapid identification of coagulopathy, especially in children, and administration of antivenom |
Stroke | CT scanner with POCT | Stroke ambulance | Rapid discovery of ischemic stroke, earlier administration of thrombolytics, transport directed to stroke centers without delay, and improved outcomes |
Transfusion support | POC Hct/Hgb, blood typing (A, B, O, and Rh) | Drone-facilitated delivery of blood products to outlying islands, transport of specimens for diagnostic tests | Fundamental life support where it is lacking due to isolation in emergency situations |
Tuberculosis | Fuji X Air ultraportable digital CXR with AI + battery-powered POC TrueNAT molecular Dx instrument | Mobile van and rotating peripheral healthcare screening for TB and rifampicin resistance in the community. USAID TB Initiative. First WHO-recommended rapid (1 h) molecular test for the detection of Mycobacterium tuberculosis complex bacteria and rifampicin resistance | Unique case finding program underway already finds ~ 9% infected with TB of first 432 patients screened in the Bantayan community. Low-cost testing with minimal biosafety requirements. Computer-aided detection of TB on CXR using artificial intelligence |