Patient and doctor

How Citra Urgent Care leveraged a pioneering test platform to meet the evolving needs of patients and build a new business model during a pandemic

Rapid RT-PCR COVID-19 testing delivers accurate results within ~30 minutes so urgent care clinics can treat more patients, faster

As their name so aptly promises, urgent care clinics help keep people healthy by offering accessible, fast, and high-quality medical services. When COVID-19 prompted an unanticipated surge in illnesses accompanied by supply chain constraints and a growing demand for testing, many facilities struggled to operate with their normal level of efficiency. With sudden, unpredictable increases in case counts placing more strain on the healthcare system, some urgent care clinics ultimately became unable to provide key medical services during a time when communities were in dire need [1].

Citra Urgent Care, however, found a way to overcome the many challenges they faced early in the pandemic. Led by a commitment to Truly Transparent® care that prioritizes patients, the Dallas-Fort Worth area network leveraged an ambitious testing strategy to keep all five clinics open, providing the highest standard of quality care despite shifting circumstances and overwhelming need.

Lab-based testing didn’t support the “urgent” part of the urgent care model, so Citra turned to rapid PCR for fast, accurate results

Dr. Nick Karr, founder of Citra Urgent Care

“Providing high-quality healthcare comes down to the simple things – doing the right thing and putting yourself in the patient’s shoes. At Citra, our approach to the pandemic has been to say, ‘We’re all doing our best – let’s try to solve the problems together.’ Rapid PCR has been a big part of the solution.” – Dr. Nick Karr, founder of Citra Urgent Care

The long and unpredictable turnaround time of lab-based PCR COVID-19 tests, especially in the beginning of the pandemic, prevented the Citra team from being able to deliver the timely care they strive for. In some cases, patients were receiving results after they were out of quarantine. While faster antigen tests became available early on, the Citra team preferred having a molecular PCR option due to the known superior accuracy and reliability PCR offers [2]. “COVID-19 accelerated a lot of trends that were already in place, and increased adoption of molecular point-of-care tests is just one example. The public is increasingly understanding of the advantages of PCR over antigen in terms of accuracy,” said Dr. Karr.

Dr. Karr knew that technology would eventually catch up to achieve the “sweet spot” for testing — the speed of antigen with the accuracy of PCR. That’s where the Thermo Scientific Accula SARS-CoV-2 Test, which uses rapid RT-PCR technology to produce accurate results in approximately 30 minutes, ultimately delivered. The Accula SARS-CoV-2 Test relies on a portable, palm-sized dock that plugs into a standard outlet, with 10-second dock initiation/start-up and no data entry required. When a sample is loaded in a cassette, the system amplifies the molecular target, detects the SARS-CoV-2 virus, and delivers test results.

Authorized for use in CLIA-waived environments, the Accula platform was easy to add to the existing list of tests Citra is authorized to run in the clinic. Additionally, commonly circulating, surge-driving variants, such as Delta and Omicron, were not found to impact Accula test performance [3].

Dr. Karr sees Citra’s ability to leverage the rapid PCR technology, offered by Thermo Fisher Scientific’s Accula platform as critical to the team’s success in continuously providing much needed medical services for the community, even during the most hectic times of the pandemic. “I have so much gratitude for the Accula SARS-CoV-2 Test. Getting a result we can trust in real time allows us to provide the best possible care to our patients, and Thermo Fisher has worked closely with us to make sure we have everything we need along the way.”

While many clinics became overwhelmed by COVID-19 testing demand, rapid PCR inspired a sustainable testing service designed to meet community needs

As the demand for COVID-19 testing increased, the Citra team recognized a clear divide — some patients were looking for medical care as well as testing, while others needed a PCR test to confirm their COVID-19 status for employment, school, event attendance, or travel purposes.

To best serve both populations, Citra streamlined test offerings, providing a walk-up cash-pay testing service—no appointment needed. An efficient alternative to the status quo, Dr. Karr shared, “People could get in and out with accurate results much faster, and by doing that, it helped us accommodate more people who needed medical care.” The fast turnaround time and control of the testing process allowed Citra to build this model, versus sending samples out for analysis and being at the mercy of a lab’s turnaround time.

Reliable, rapid PCR test for the detection of SARS-CoV-2 in ~30 minutes

The Accula system is small, portable, and easy to use with minimal training required. These features, along with the ability to deliver accurate PCR results in approximately 30 minutes, support the timely delivery of actionable care in a clinic setting.
To see what happens inside an Accula test cassette, watch this video that follows a patient sample from collection to results.

Point-of-care rapid PCR testing can promote more efficient, continuous, and coordinated care, beyond COVID-19

When testing for infectious diseases, having reliable results quickly can greatly affect clinical decisions and patient outcomes. For example, antiviral treatment is available for someone who has the flu, but the clinical benefit of the therapy is greatest if the regimen is started within 48 hours of symptom onset [4]. As more treatments for COVID-19 are expected to become available [5], the ability to coordinate care and schedule onsite treatment before a patient leaves the building will become increasingly valuable.

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“You don’t just want accurate information; you want actionable information. And how actionable is a result if you’re getting it days later? By then, the disease could be in a different stage, and the patient’s condition could have changed.” - Dr. Nick Karr

Dr. Karr reinforced the general importance of fast, accurate results in his practice. “You don’t just want accurate information; you want actionable information. And how actionable is a result if you’re getting it days later? By then, the disease could be in a different stage, and the patient’s condition could have changed.” He also points to the added benefit of being able to retest someone right away when a result is surprising, along with improved continuity of care in allowing the provider who assessed a patient to receive a result and make the most appropriate decision for treatment.

Rapid antigen tests have been used for a spectrum of illnesses in the urgent care setting, but Dr. Karr sees a major shift toward molecular options, like PCR, due to their improved accuracy [2]. He added, “We are now looking at a range of diseases and asking, ‘Is there a molecular test option?’ These tests directly influence treatment plans and lead to better outcomes. Point-of-care molecular testing isn’t going anywhere — it’s only going to increase.”

Affordable and portable molecular diagnostic devices allow providers to gain control of infectious disease testing

The Accula platform utilizes an innovative technology for PCR amplification and virus detection, bypassing the need for large, sophisticated equipment that can be cost prohibitive for sites not exclusively focused on laboratory services. This more cost-effective solution is also compact and portable, so tests can be processed in small workspaces without the need for a dedicated, large lab space.

Because of the favorable price point, the Citra team was able to purchase ten Accula docks per clinic location and now processes approximately 500 rapid PCR tests per day. Having many systems in place adds to the robustness of their testing model, as they aren’t risking significant capacity changes if one system was to fail, which can happen when labs rely on one or few pieces of equipment. Additionally, the Accula cartridge insert can easily be replaced and a test can be rerun with a new cartridge, as needed.

Providing the best possible patient care consistently guides Citra’s decisions. The Accula test’s turnaround and clear training process aligned with that commitment, allowing team members more time and energy to focus on patients. Overall, Dr. Karr has found the platform user-friendly, familiar and easy to implement. He shared, “Like many of the antigen tests we run, I’ve ended up asking myself, why aren’t we doing more of this kind of testing?”

To learn more about Thermo Fisher Scientific’s rapid PCR test for COVID-19, go to the Accula SARS-CoV-2 Test webpage or contact us to request a quote.

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References:
1. Urgent-care providers temporarily close some locations, citing omicron surge | Crain's New York Business (crainsnewyork.com)
2. Khandker, S. S., Nik Hashim, N., Deris, Z. Z., Shueb, R. H., & Islam, M. A. (2021). Diagnostic Accuracy of Rapid Antigen Test Kits for Detecting SARS-CoV-2: A Systematic Review and Meta-Analysis of 17,171 Suspected COVID-19 Patients. Journal of clinical medicine, 10(16), 3493.
3. Impact of SARS-CoV-2 Omicron variants on the performance of the Thermo Fisher Scientific Accula SARS-CoV-2 Test
4. https://www.fda.gov/media/76542/download
5. https://www.nytimes.com/2021/12/03/briefing/covid-treatments-pfizer-merck.html

Disclaimer: This Accula SARS-CoV-2 Test has not been FDA cleared or approved but has been authorized for emergency use by FDA for use by laboratories certified under the Clinical Laboratory Improvement Amendments (CLIA) of 1988, 42 U.S.C. §263a, that meet requirements to perform high, moderate, or waived complexity tests. The test is authorized for use at the Point of Care (POC), i.e., in patient care settings operating under a CLIA Certificate of Waiver, Certificate of Compliance, or Certificate of Accreditation. This test has been authorized only for the detection of nucleic acid from SARS-CoV-2, not for any other viruses or pathogens. The emergency use of this test is only authorized for the duration of the declaration that circumstances exist justifying the authorization of emergency use of in vitro diagnostics for detection and/or diagnosis of COVID-19 under Section 564(b)(1) of the Federal Food, Drug, and Cosmetic Act, 21 U.S.C. § 360bbb-3(b)(1), unless the declaration is terminated or authorization is revoked sooner.

For Use under the Emergency Use Authorization (EUA) Only. For prescription use only. For in vitro diagnostic use.

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