Patient-Centred Point-of-Care Testing: A Life-Changing Technology for Remote Primary Care

Abstract

Point-of-care (POC) testing has proven to be a life-changing and transformational technology for patients with acute, chronic, and infectious diseases who live in regional and remote Australia. This technology facilitates patient-centred test results, of equivalent laboratory quality, that are rapidly available to inform clinical and public health decisions with immediate impact on case management. Traditionally, POC testing in high-middle income countries has been most widely used in tertiary or acute care settings to provide rapid diagnostic results for emergency departments, intensive care units, operating theatres and outpatient clinics. However, in low-middle income countries, POC tests are commonly used during antenatal and perinatal care for infectious disease detection, such as Human immunodeficiency virus (HIV) or syphilis, where laboratory services are too expensive, inaccessible, or non-existent. Similarly, the application of POC testing in primary care settings in Australia offers improved healthcare benefits to geographically isolated regional and remote communities, where access to laboratory-based pathology testing is poor and the burden of disease is high. Evidence-based data from research in established primary care POC testing networks for acute chronic, and infectious disease is used to describe the clinical, cultural, and economic effectiveness of POC technologies. Innovative solutions to address current barriers to the uptake of POC testing in primary care settings, which include clinical and cultural governance, high staff turnover, operator training and competency, device connectivity, quality testing, sustainable funding strategies, and the need for regulatory requirements are also discussed. POC testing can provide practical and resourceful opportunities to revolutionise the delivery of pathology services in rural and remote primary care sectors, where the clinical and community need for this technology is greatest. However, several barriers to the scale-up and sustainability of POC testing networks in these settings still exist, and the full potential of POC testing cannot be realised until these limitations are addressed and resolved.

Point-of-Care Testing in Rural and Remote Australia: An Emerging Technology to Address Global Health Challenges, Crises and Security

“…Australia has been a pioneer and leader in both the application of POC testing in primary care-particularly services supporting Aboriginal and Torres Strait Islander (now more commonly referred to as First Nations) communities-for the past 25 years. Large-scale POC testing networks (involving close to 100 or more rural and remote First Nations health services) now operate for chronic, acute and infectious diseases across the length and breadth of Australia (Table 1); these are managed for the Australian Government by specialist POC testing network providers including the Flinders University International Centre for Point-of-Care Testing and the Kirby Institute, University of New South Wales, in collaboration with peak First Nations bodies and leadership groups, rather than by traditional pathology laboratories [2,[4][5][6].…”

“…The Territory's land mass, Testing, has revolutionised pathology service delivery in the Territory, particularly for acute medical emergencies such as acute myocardial infarction, acute respiratory disorders, acute renal disease and acute blood loss [11,12]. The ability to perform opportunistic tests for cardiac troponin, blood gases, electrolytes and creatinine, and haemoglobin, respectively, have enabled efficient triage of acutely ill patients [13]. The device's international normalised ratio (INR) test also enables the management of patients on warfarin therapy.…”

“…Point-of-care (POC) testing has specific relevance for rural or remote primary care environments, where geographic isolation and long distances from the nearest pathology service can lead to traditional laboratory processes being compromised; sample integrity becomes a major issue due to harsh transport conditions while long turnaround times for results to be returned to remote services result in loss to followup of patient care [4,5].…”

Pathology Testing at the Point of Patient Care: Transformational Change for Rural Communities

“…The study investigated 200 patient cases with three acute medical presentations at six remote health services: patients with acute chest pain (n = 147), patients with acute diarrhoea (n = 25) and patients with acute exacerbation of renal failure due to a missed dialysis session (n = 21). POC testing enabled more informed triaging of acutely ill patients evacuation to a tertiary hospital as well as ruling out the need for evacuation for patients who could remain in the community and be stabilised [34].…”

“…POC testing networks within remote Australia have demonstrated that when governments have the political will and are prepared to invest in POC testing and required infrastructure then clinical, operational, cultural and economic benefits can be derived for both the patient and healthcare system [5]. This is particularly evident for remote communities and marginalised populations, where access to centralised pathology laboratories is limited and loss to follow-up is high [6].…”