Economic evaluation of point-of-care testing in the remote primary health care setting of Australia's Northern Territory.

Aim: To 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.

Methods: A 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.

Point-of-care testing for haemoglobin A1c in remote Australian Indigenous communities improves timeliness of diabetes care.

Introduction: In remote Australia timely access to pathology results and subsequent follow-up of patients for treatment is very challenging due to the long distances to the nearest laboratory. Point-of-care testing (POCT) offers a practical solution for pathology service provision in such remote communities. Since 2008, POCT for haemoglobin A1c (HbA1c) has been conducted in remote Northern Territory (NT) health centres for diabetes management of Indigenous patients through the national Quality Assurance in Aboriginal and Torres Strait Island Medical Services (QAAMS) Program.

Design, implementation and initial assessment of the Northern Territory Point-of-Care Testing Program.

Objective: The objective of the study was to improve pathology services in selected remote health centres from the Northern Territory (NT) through the implementation of a quality managed point-of-care pathology testing (POCT) service.

Design: Study of the efficacy of the POCT service after 1 year and qualitative survey of POCT device operators.

Setting: The study was set in thirty-three remote health centres in the NT administered by the NT Department of Health.

Change of HbA1c reporting to the new SI units.

An international consensus statement recommends that dual reporting of haemoglobin A (HbA(1c)) levels--in the current units (percentage) and Système International (SI) units (mmol/mol)--be used as an interim measure for a 2-year transition period before progressing towards the use of SI units only. This recommendation is supported by the Australasian Association of Clinical Biochemists, the Australian Diabetes Educators Association, the Australian Diabetes Society and the Royal College of Pathologists of Australasia. The SI units are a true measure of HbA(1c) and remove potential confusion between HbA(1c) values and blood glucose values.

Development of an accreditation program for Point of Care Testing (PoCT) in general practice.

Objectives: To describe the development and evaluation of an accreditation program for Point of Care Testing (PoCT) in general practice, which was part of the PoCT in general practice (GP) Trial conducted in 2005-07 and funded by the Australian Government.

Setting And Participants: Thirty general practices based in urban, rural and remote locations across South Australia, New South Wales and Victoria, which were in the intervention arm of the PoCT Trial were part of the accreditation program. A PoCT accreditation working party was established to develop an appropriate accreditation program for PoCT in GP.

Point-of-Care Testing and Creatinine Measurement.

This paper reviews the current status of point-of-care testing (PoCT) devices that are available for measuring whole blood or serum/plasma creatinine globally and within Australasia. Information on non-analytical specifications and analytical performance is provided using data sourced from recently published literature, external quality assurance programs and evaluative work by the author's unit. The limitations of current devices are summarised.

Assessing agreement between point of care and laboratory results for lipid testing from a clinical perspective.

Objectives: Investigate agreement between lipid pathology results from point-of-care testing (PoCT) devices and laboratories.

Design And Methods: Agreement was assessed using the Bland-Altman method.

Results: : Mean difference (limits of agreement) were: -0.

Evaluation of a training program for device operators in the Australian Government's Point of Care Testing in General Practice Trial: issues and implications for rural and remote practices.

Introduction: From September 2005 to February 2007 the Australian Government funded the Point of Care Testing (PoCT) in General Practice Trial, a multi-centre, cluster randomised controlled trial to determine the safety, clinical effectiveness, cost-effectiveness and satisfaction of PoCT in General Practice. In total, 53 practices (23 control and 30 intervention) based in urban, rural or remote locations across three states (South Australia [SA], New South Wales [NSW] and Victoria [VIC]) participated in the Trial. Control practices had pathology testing performed by their local laboratory, while intervention practices conducted pathology testing by PoCT.

Influence of geography on the performance of quality control testing in the Australian Government's point of care testing in general practice trial.

Objective: To investigate the influence of geography on quality control (QC) testing in the point of care testing (PoCT) in general practice trial.

Design And Methods: Within-practice imprecision for QC testing for HbA1c, urine albumin:creatinine ratio, lipids and international normalised ratio was calculated for each geographic region.

Results: There was no significant difference between the region of testing and within-practice imprecision, except for triglyceride and HDL cholesterol.

Results of an innovative education, training and quality assurance program for point-of-care HbA1c testing using the Bayer DCA 2000 in Australian Aboriginal Community Controlled Health Services.

This study describes the development, implementation and management of a multi-faceted quality assurance program called Quality Assurance for Aboriginal Medical Services (QAAMS) to support point-of-care HbA(1c) testing on the Bayer DCA 2000 in Aboriginal people with diabetes from 45 Australian Aboriginal Community Controlled Health Services. The quality assurance program comprised four elements: production of culturally appropriate education resources, formal training for Aboriginal Health Workers conducting HbA(1c) testing, an external quality assurance program and on-going quality management support services including a help hotline and an annual workshop. Aboriginal Health Workers were required to test two quality assurance (QAAMS) samples in a blind sense every month since July 1999.

Comparative performance of two point-of-care analysers for lipid testing.

The aim of this study was to compare the analytical performance of the Cholestech LDX and CardioChek PA lipid point-of-care devices to a CDC-certified laboratory. Inter-assay imprecision (n=10) for blood samples from 2 patients with different lipid profiles was 3.0% for total cholesterol, 2.

The analytical quality of point-of-care testing in the 'QAAMS' model for diabetes management in Australian aboriginal medical services.

Type 2 diabetes mellitus and its major complication, renal disease, represent one of the most significant contemporary health problems facing Australia's Indigenous Aboriginal People. The Australian Government-funded Quality Assurance for Aboriginal Medical Services Program (QAAMS) provides a framework by which on-site point-of-care testing (POCT) for haemoglobin A1c (HbA(1c)) and now urine albumin:creatinine ratio (ACR) can be performed to facilitate better diabetes management in Aboriginal medical services. This paper provides updated evidence for the analytical quality of POCT in the QAAMS Program.

Cultural and clinical effectiveness of the 'QAAMS' point-of-care testing model for diabetes management in Australian aboriginal medical services.

The national Quality Assurance for Aboriginal Medical Services (QAAMS) Program, in which point-of-care testing (POCT) for haemoglobin A(1c) (HbA(1c)) and urine albumin: creatinine ratio (ACR) is performed for diabetes management in 65 Australian Aboriginal medical services, is now embedded in the practice of diabetes care across Indigenous Australia. This paper documents the results of a detailed survey to assess levels of satisfaction with the QAAMS HbA(1c) Program among three key stakeholder groups-doctors, POCT operators and patients with diabetes. Both doctors and patients with diabetes agreed that the immediacy of POCT results contributed positively to patient care, improved the doctor-patient relationship, and made the patient more likely to be both compliant and self-motivated to improve their diabetes control.

The impact of point of care testing on diabetes services along Victoria's Mallee Track: results of a community-based diabetes risk assessment and management program.

Introduction: In the State of Victoria in Australia, diabetes is considered one of the top 10 health problems for people living in the rural Mallee Track region (which is centred on the town of Ouyen and extends west to the border with South Australia). A project entitled 'Diabetes Management Along the Mallee Track' was conducted through a Rural Chronic Disease Initiative (RCDI) program grant from the Australian Government's Department of Health and Ageing, Canberra, with the aim of improving the delivery of diabetes services in this region. The project's aims were achieved through the implementation of a community risk assessment program and the establishment of an integrated, multidisciplinary 'one-stop' service for the management of people with diabetes.

Point-of-care testing of HbA1c and blood glucose in a remote Aboriginal Australian community.

Objectives: To assess the accuracy of point-of-care (POC) measurements of capillary blood glucose and glycosylated haemoglobin (HbA(1c)) levels in a remote Aboriginal community with high diabetes prevalence.

Design: Cross-sectional study comparing POC capillary glucose and HbA(1c) results with those from corresponding venous samples measured in a reference laboratory.

Participants And Setting: 152 residents aged 11-76 years (representing 76% of population aged over 11 years) had POC glucose measurement in November 2003; 88 with POC glucose level > or = 5.

Nutrition project in a remote Australian aboriginal community.

Much of the ill health of Australian indigenous populations can be attributed to diet-related diseases. This community nutrition project is part of a wider renal screening and prevention program based in the Umoona aboriginal community in Coober Pedy in South Australia's far north. The nutrition project facilitates the capacity of the Umoona aboriginal community to identify and redress nutrition-related issues considered important in improving their overall health status.