Developing a sustainable framework for managing the implementation and assessing the effectiveness of Point-of-Care Testing in remote settings

Author: Brooke Spaeth

Spaeth, Brooke, 2018 Developing a sustainable framework for managing the implementation and assessing the effectiveness of Point-of-Care Testing in remote settings, Flinders University, College of Medicine and Public Health

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Abstract

Introduction: Point-of-care testing (POCT) is pathology testing performed at the site of patient care with results immediately available to inform clinical decisions. POCT is different from traditional laboratory-based pathology testing which requires patient specimens to be transported to a laboratory with test results later reported to the treating practitioner; this can cause delays to the initiation of, or changes in, clinical management. POCT has a particular niche in rural and remote locations where the increased distance from the nearest laboratory lengthens transport times, extends delays in receiving pathology results and can result in loss to patient follow-up. However, the evidence base to support the use of POCT in rural and remote settings is limited as most POCT studies have occurred in urban general practice or metropolitan tertiary hospital settings. In particular, very little evidence exists for the use of POCT for acute care in rural or remote primary health care settings.

Methods: This thesis documents ten years of quantitative and qualitative research into the effectiveness of POCT in rural and remote settings. Most of this work was facilitated by the author’s role as the Coordinator of POCT services in the Northern Territory (NT) of Australia; one of the most remote and challenging environments for POCT delivery. Thirteen peer-reviewed studies provide a large evidence-base supporting the use of POCT in these settings. The studies focus on the implementation and assessment of key outcomes of POCT and represent the most comprehensive research assessment conducted to date on the effectiveness of POCT in remote Australia.

Results: In the NT remote primary care setting, POCT was determined to be analytically sound with results of quality control testing performed by remote operators being consistently of equivalent quality to laboratory benchmarks.

Operational effectiveness was demonstrated through the increased uptake of POCT in the NT (with volume of testing increasing 600% since initial implementation), and significant increases in satisfaction with pathology services post introduction of POCT. More than 1,500 health professionals have now been trained as POCT operators contributing to significant workforce capacity building and increased community resilience. The improved timeliness of pathology results by POCT has enabled more rapid initiation and changes to treatment.

Clinical effectiveness of POCT is highlighted through case studies documenting clinical benefits to patients, including improvements in glycaemic control and increased time in therapeutic range. For acute care, POCT has made significant improvements to patient safety through enabling informed stabilisation of patients on-site, and enhanced decision-making regarding the triage and prioritisation of patients requiring emergency medical retrievals.

An economic evaluation of POCT identified savings to the NT health sector estimated to be upwards of $21 million per annum for three common acute presentations.

The robustness of the methods developed for the NT POCT model were also verified through translation to an international setting and with different POC tests.

Impact: Collectively, this body of evidence-based research has significantly shaped government policy on pathology service provision in the NT, with POCT now embedded in mainstream service delivery in every remote health facility.  

Keywords: point-of-care testing, rural health, remote health, acute, sustainable

Subject: Pathology thesis, Medical Science thesis, Public Health thesis

Thesis type: Doctor of Philosophy
Completed: 2018
School: College of Medicine and Public Health
Supervisor: Professor Mark Shephard