Respiratory illness season means patients with overlapping symptoms necessitating testing to determine appropriate treatment, if self-quarantine is needed, and to avoid antibiotic overuse. While polymerase chain reaction (PCR) and nucleic acid amplification tests can greatly speed the results of testing, receiving results at clinics, urgent care centers, or rural healthcare centers can mean lost time in logistics and transit between laboratories and these care centers.

A collaboration between a rural, urgent care center network and diagnostics company may be laying the groundwork for speeding up the time waiting for laboratory results.

Delays in Rural Settings

While PCR technology has been in use for decades, there has been a lag in the advanced logistics needed to deliver results more quickly. Starting as a pilot project in 2022, HealthTrackRx, an accredited laboratory, worked in conjunction with UPS Healthcare and a laboratory based in Louisville, Kentucky. The project resulted in delivery of next-morning test results when the lab received test samples the previous morning. Following that success, HealthTrackRx has opened a 100,000-square-foot facility that combined laboratory services and automated logistics.

For organizations such as Fast Pace Health, which predominately serve patients in rural areas, they often navigate longer than typical wait times for test results. For these clinicians and patients, a shorter turnaround could affect the initial care plan. Speedier testing could get the best medication into patients’ hands more quickly and avoid unnecessary medication.

“There’s a paradigm shift of trying to get targeted treatment within a shorter turnaround time,” said Sarika Aggarwal, MD, MHCM, chief medical officer at Fast Pace Health, a network of more than 300 walk-in and urgent care centers across eight states. Aggarwal over the past year has helped to develop a program that worked in tandem with HealthTrackRx to obtain next-morning diagnostics nationwide for respiratory and other infections.

“We were looking for a way that we could get to a better place with our testing,” said Aggarwal. “And now we are changing how we can treat, because we can actually wait on specific results and treat in a targeted way vs presumptively.”

Aiding Antibiotic Stewardship

Faster results reduce the need for prescribing broad-spectrum antibiotics to treat wide-ranging conditions, in the absence of a definitive diagnosis. Such reliance on empirical therapy is becoming more difficult to justify, said Aggarwal. “We know that most urgent care centers do tend to overprescribe because it’s been presumptive care for a long time,” she said.

“We’ve typically presumed two things: there’s a virus or bacterial infection present, and that the bacteria could cause more complications,” said Aggarwal. “And so we have presumptively treated the patient, but I wouldn’t say this was ever the most appropriate or safe approach. It’s just the way medicine has been because we haven’t had an alternative.”

Patients can also push for medications before test results, potentially leading to unneeded medications and poor antibiotic stewardship.

“With reviews that occur today on Google, Yelp, or other social media, [providers are] going to feel pressure that if a patient comes in with a certain expectation and it’s not met that they’ll have a bad review, which might impact visitors to their clinic,” said Steven Goldberg, MD, chief medical officer at HealthTrackRx, and a physician on staff with University of Louisville Health in Louisville, Kentucky.

Testing Panels and Protocols

Aggarwal said she and her colleagues utilize the testing service across a variety of menus, including respiratory tract infections, genitourinary infections, wounds, and urinary tract infections.

The menu of testing options available to Fast Pace Health was a collaborative effort between its respective leadership and that at HealthTrackRx, said Aggarwal. “We have created multiple panels for bacterial, viral, and atypical pathogens as well as for sexually transmitted infections and biopsies of various lesions. We are really looking and targeting for all organisms across the health system landscape.”

The testing is further aided by a simplified protocol, Aggarwal said, with only one tube and one swab being required, whether it be a nasal swab, genitourinary swab, or cervical swab. “While this may seem like a minor operational detail, it actually reduces many errors in terms of potentially using the wrong tube or using the wrong swab and having to ask the patient to return for an additional test,” she said.

“The collection mechanism is standardized,” said Aggarwal. “We, of course, have to label it appropriately, but there is no color-coordinating necessary for labeling or having to hang a chart to identify which tube to use. This has really helped streamline our collection process.”

Real-Time Respiratory Data

Among the ancillary services offered by HealthTrackRx is a Respiratory Trend Report that is issued biweekly and uses its own ongoing nationwide next-morning results. While the data are specific to tests processed by HealthTrackRx, it is another resource accessible to clinicians on infectious disease trends statewide and nationally.

“We’re always able to see, based on our test results, what is happening nationally,” said Goldberg. “Respiratory season is a very difficult time for many people and providers have a lot of interest in knowing where we are in the peak of flu season, or which strain is dominant, or what is happening with other viruses that also impact individuals that aren’t tracked in the same way that the most common types are.”

“Knowing that information is really helpful when advising patients after an exam,” said Goldberg. “Our reports also provide an easy way for clinicians to engage with patients in a shared decision-making conversation and to coach them with strategies when an antibiotic won’t be helpful.”

Aggarwal reported having no relevant financial disclosures.