Exploring Workplace Testing with Real-Time Polymerase Chain Reaction SARS-CoV-2 Testing.

BACKGROUND: Molecular tests (ie, real-time polymerase chain reaction [RT-PCR]) and antigen tests are used to detect SARS-CoV-2. RT-PCR tests are generally considered to be the standard for clinical diagnosis of SARS-CoV-2 due to accuracy and reliability but can take longer to return results than antigen tests. Our aim was to examine if point-of-care (POC) testing for SARS-CoV-2 infection would provide a flexible resource to help achieve workplace safety. We compared test results and time-to-test results between a POC RT-PCR test and a send-out PCR test in a program implemented in summer 2020. RESULTS: POC testing shortened the time to results to 110 minutes in the POC setting from the 754 minutes for send-out tests. The specificity of POC RT-PCR single POC testing was 98.7% compared with send-out RT-PCR testing and was confirmed at 99.8% in a validation analysis. The sensitivity of the POC testing was 100% compared with send-out RT-PCR, although in a validation analysis, sensitivity appeared as 0% because only the 12 positive or indeterminate samples on the first analysis were retested and the majority were false-positives that were correctly ruled out. CONCLUSIONS: POC testing for SARS-CoV-2 with RT-PCR technology is possible at reduced time compared with send-out PCR testing.

Impact of COVID-19 on Primary Care Practice Sites and Their Vulnerable Patients.

Purpose: While COVID-19 has upended lives, it has also catalyzed innovation with potential to advance health delivery. Yet, we know little about how the delivery system, and primary care in particular, has responded and how this has impacted vulnerable patients. We aimed to understand the impact of COVID-19 on primary care practice sites and their vulnerable patients and to identify explanations for variation. Approach: We developed and administered a survey to practice managers and physician leaders from 173 primary care practice sites, October-November 2020. We report and graphically depict results from univariate analysis and examine potential explanations for variation in practices' process innovations in response to COVID-19 by assessing bivariate relationships between seven dependent variables and four independent variables. Findings: Among 96 (55.5%) respondents, primary care practice sites on average took more safety (8.5 of 12) than financial (2.5 of 17) precautions in response to COVID-19. Practice sites varied in their efforts to protect patients with vulnerabilities, providing care initially postponed, and experience with virtual visits. Financial risk, practice size, practitioner age, and emergency preparedness explained variation in primary care practices' process innovations. Many practice sites plan to sustain virtual visits, dependent mostly on patient and provider preference and continued reimbursement. Value: While findings indicate rapid and substantial innovation, conditions must enable primary care practice sites to build on and sustain innovations, to support care for vulnerable populations, including those with multiple chronic conditions and socio-economic barriers to health, and to prepare primary care for future emergencies.