Isotope dilution mass spectrometry alignment of the StatSensor will identify most patients with estimated glomerular filtration rate <60 mL/min, but there will be many falsely low estimated glomerular filtration rate results that require laboratory validation. Creatinine results need improvement.

The COVID-19 pandemic is growing rapidly, with over 37 million cases and more than 1 million deaths reported by mid-October, 2020, with true numbers likely to be much higher in the many countries with low testing rates. Many communities are highly vulnerable to the devastating effects of COVID-19 because of overcrowding in domestic settings, high burden of comorbidities, and scarce access to health care. Access to testing is crucial to globally recommended control strategies, but many communities do not have adequate access to timely laboratory services. Geographic dispersion of small populations across islands and other rural and remote settings presents a key barrier to testing access. In this Personal View, we describe a model for the implementation of decentralised COVID-19 point-of-care testing in remote locations by use of the GeneXpert platform, which has been successfully scaled up in remote Aboriginal and Torres Strait Islander communities across Australia. Implementation of the decentralised point-of-care testing model should be considered for communities in need, especially those that are undertested and socially vulnerable. The decentralised testing model should be part of the core global response towards suppressing COVID-19.

AimTo determine the cost-effectiveness of utilizing point-of-care testing (POCT) on the Abbott i-STAT device as a support tool to aid decisions regarding the emergency medical retrievals of patients at remote health centers in the Northern Territory (NT) of Australia.MethodsA decision analytic simulation model–based economic evaluation was conducted using data from patients presenting with three common acute conditions (chest pain, chronic renal failure due to missed dialysis session(s), and acute diarrhea) at six remote NT health centers from July to December 2015. The specific outcomes measured in this study were the number of unnecessary emergency medical retrieval prevented through POCT. Cost savings through prevented unnecessary medical retrievals for each presentation type were then determined and extrapolated to give per annum NT-wide estimates.ResultsPOCT prevented 60 unnecessary medical evacuations from a total of 200 patient cases meeting the selection criteria (48/147 for chest pain, 10/28 for missed dialysis, and 2/25 for acute diarrhea). The associated cost savings were AUD $4,674, $8,034, and $786 per patient translating to NT-wide savings of AUD $13.72 million, $6.45 million, and $1.57 million per annum (AUD $21.75 million in total) for chest pain, missed dialysis, and acute diarrhea presentations, respectively.ConclusionThis study demonstrated that POCT when used to aid decision making for acutely ill patients delivered significant cost savings for the NT health care system by preventing unnecessary emergency medical retrievals.

The NT POCT Program has been operationally effective and well received by staff working as i-STAT POCT operators in remote health centres. Retention of remote health centre staff is the most significant challenge to ensuring the program's long-term viability.

No abstract

No abstract

Among Indigenous people of Australia's Northern Territory, the prevalence of rheumatic heart disease is one of the highest in the world. Warfarin is a common anticoagulant used to treat this condition and to minimize risk of a cardiac event. International normalized ratio (INR) testing is used routinely to monitor the efficacy of warfarin therapy and to ensure a patient's INR remains within a tight therapeutic range. Since 2008, the i-STAT point-of-care testing (POCT) device has been used to measure INR for patients on warfarin therapy in 32 remote health centers participating in the Northern Territory POCT Program. A training and quality program to support i-STAT INR POCT is delivered by Flinders University International Centre for POCT and offers flexible options for training including on-site workshops, interactive teleconference training, and training via e-learning. Since 2008, more than 13,000 INR POCTs have been performed on more than 900 patients. Two hundred ninety-eight patients have had 5 or more INR POCTs performed, and 212 of these have had more than 10 serial INR tests. The volume of patient INR testing has increased every year of the program, from 853 in 2008 to 3332 in 2014 (representing a 291% increase in testing since the program's inception). The number of remote health staff trained as POCT device operators is now greater than 700. The between-site imprecision (CV%) from monthly INR quality control testing has averaged 6.3% over the past 6 years (range, 4.6%-7.6%). A clinical audit of patient cases has identified improved clinical outcomes and operational benefits through POCT.

Since 2008 in Australia, the Northern Territory (NT) department of health has been in partnership with the Community Point-of-Care Services unit (now the Flinders University International Centre for Point-of-Care Testing) to deliver quality-assured point-of-care testing on the i-STAT device (Abbott Point of Care, Doncaster, Australia) for the provision of selected pathology services in 33 of its remote health centers in the Territory. A set of agreed research outcomes were developed jointly to assess and validate the operational and clinical effectiveness as well as the analytical safety of point-of-care (POC) testing in remote NT health centers.Across the first 4 years of the program, more than 500 health professional staff have been trained as qualified POC testing operators, and more than 21,250 patient tests on the i-STAT have been performed. Analytical quality for POC testing has met profession-based analytical goals and/or state-of-the-art laboratory performance for most tests. Clinical case studies sourced from the i-STAT central data station (which electronically captured deidentified patient and quality data from all remote services) has confirmed the clinical effectiveness of POC testing for acute and chronic conditions. Community satisfaction with POC testing was validated using qualitative surveys of device operators. Greater than 80% of respondents believed POC testing was more convenient than the laboratory and assisted in the stabilization of patients with acute illness. The Northern Territory i-STAT Point-of-Care Testing Program has therefore proven operationally effective, analytically sound, clinically and culturally effective, and has been well-received by health professional staff. FIGURE 2. Total number of i-STAT patient tests conducted across the first 4 years of operation of the program, split by cartridge type. Shephard et al