Review of the cultural safety of a national Indigenous point-of-care testing program for diabetes management

Abstract

In Australia, Aboriginal and Torres Strait Islander people have approximately three-fold higher rates of diabetes than non-Indigenous Australians. Point-of-care testing, where pathology tests are conducted close to the patient, with results available during the patient consultation, can potentially deliver several benefits for both the Indigenous client and the health professional team involved in their care. Currently, point-of-care testing for diabetes management is being conducted in over 180 Aboriginal and Torres Strait Islander Medical Services as part of a national program called Quality Assurance for Aboriginal and Torres Strait Islander Medical Services (QAAMS). The cultural safety of the Program was reviewed by sourcing the views of the QAAMS Indigenous Leaders Team in a focus group setting and by surveying the point-of-care testing operators enrolled in QAAMS, via an electronic questionnaire. The current study confirms that QAAMS remains a culturally safe program that fills a permanent and positive niche within the Indigenous health sector. The study demonstrates that QAAMS provides a convenient and accessible 'one-stop' pathology service for Indigenous clients with diabetes and empowers Aboriginal Health Workers to have a direct role in the care of their diabetes clients.

Type 2 Diabetes and Indigenous Peoples

“…In Alberta, substantial numbers of Indigenous individuals with abnormalities have been identified through community-based screening with point-of-care (POC) instruments handled by trained health-care professionals and associated with a quality control program (72). POC A1C screening has shown to be sufficiently accurate as a screening tool for diagnosing diabetes in remote communities (73,74); however, currently, no POC A1C analyzers are approved for the diagnosis of diabetes in Canada (see Monitoring Glycemic Control chapter, p. S47).…”

A model of culturally‐informed integrated diabetes education and eye screening in indigenous primary care services and specialist diabetes clinics: Study protocol

“…Many patients lack diabetes health literacy and knowledge of the meaning of their HbA1c test levels (Gopalan et al., 2018) and the importance of optimizing HbA1c levels in safe ranges or an appropriate individualized target to reduce the risk of long‐term diabetes complications (Moghadam et al., 2018) and why HbA1c monitoring is recommended every 3–6 months (Australian Government Department of Health, 2016). Hence, the Quality Assurance for Aboriginal and Torres Strait Islander Medical Services (QAAMS) point‐of‐care testing (Shephard et al., 2016) HbA1c conversion chart (Qaams Quality Assurance for Aboriginal Torres Strait Islander Medical Services, 2020; Figure S5) will be discussed with them. Visit 2 will take place at 12 months (with a minimum time period between assessments of 3 months) after the baseline visit and will involve a repeat DR screen to check for DR and assess adherence to annual screening recommendations.…”

The Benefits and Challenges of Point-of-Care Testing in Rural and Remote Primary Care Settings in Australia

“…The QAAMS network now operates in more than 220 sites across Australia, with sites conducting POC testing for hemoglobin A 1c for the diagnosis and management of diabetes and urine albumin to creatinine ratio for the early detection of renal disease. 16,17 Maps showing the general locations of sites participating in the Northern Territory, TTANGO, syphilis, and QAAMS POC testing networks are shown in Figure 1.…”

“…Both the QAAMS and TTANGO2 Indigenous POC testing networks have an Indigenous Leaders Team, comprising Aboriginal health professionals from each state who live and work in the community they service and who have shown strong commitment to the network. 17 The Indigenous Leaders Teams act as cultural ambassadors for their networks, advise the management committee on culturally safe practices, review all training resources, and provide support and advocacy for each program and its participants. The chair of the Leaders Team sits on the network's management committee, and the Leaders Team meets with the management committee at least twice yearly.…”