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Eades LE, Hoi AY, Liddle R, Sines J, Kandane-Rathnayake R, Khetan S, Nossent J, Lindenmayer G, Morand EF, Liew DFL, Rischmueller M, Brady S, Brown A, Vincent FB. Systemic lupus erythematosus in Aboriginal and Torres Strait Islander peoples in Australia: addressing disparities and barriers to optimising patient care. THE LANCET. RHEUMATOLOGY 2024:S2665-9913(24)00095-X. [PMID: 38971169 DOI: 10.1016/s2665-9913(24)00095-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 01/24/2024] [Accepted: 04/10/2024] [Indexed: 07/08/2024]
Abstract
The first inhabitants of Australia and the traditional owners of Australian lands are the Aboriginal and Torres Strait Islander peoples. Aboriginal and Torres Strait Islander peoples are two to four times more likely to have systemic lupus erythematosus (SLE) than the general Australian population. Phenotypically, SLE appears distinctive in Aboriginal and Torres Strait Islander peoples and its severity is substantially increased, with mortality rates up to six times higher than in the general Australian population with SLE. In particular, Aboriginal and Torres Strait Islander peoples with SLE have increased prevalence of lupus nephritis and increased rates of progression to end-stage kidney disease. The reasons for the increased prevalence and severity of SLE in this population are unclear, but socioeconomic, environmental, and biological factors are all likely to be implicated, although there are no published studies investigating these factors in Aboriginal and Torres Strait Islander peoples with SLE specifically, indicating an important knowledge gap. In this Review, we summarise the data on the incidence, prevalence, and clinical and biological findings relating to SLE in Aboriginal and Torres Strait Islander peoples and explore potential factors contributing to its increased prevalence and severity in this population. Importantly, we identify health disparities and deficiencies in health-care provision that limit optimal care and outcomes for many Aboriginal and Torres Strait Islander peoples with SLE and highlight potentially addressable goals to improve outcomes.
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Affiliation(s)
- Laura E Eades
- Centre for Inflammatory Diseases, Monash University, Clayton, VIC, Australia; Rheumatology Department, Monash Health, Clayton, VIC, Australia
| | - Alberta Y Hoi
- Centre for Inflammatory Diseases, Monash University, Clayton, VIC, Australia; Rheumatology Department, Monash Health, Clayton, VIC, Australia
| | - Ruaidhri Liddle
- Primary and Public Health Care Central Australia, Alice Springs, NT, Australia
| | - Jason Sines
- Rheumatology Department, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | | | - Sachin Khetan
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia; Rheumatology Department, Royal Darwin Hospital, Tiwi, NT, Australia
| | - Johannes Nossent
- Rheumatology Department, Sir Charles Gairdner Hospital, Nedlands, WA, Australia; School of Medicine, University of Western Australia, Crawley, WA, Australia
| | | | - Eric F Morand
- Centre for Inflammatory Diseases, Monash University, Clayton, VIC, Australia; Rheumatology Department, Monash Health, Clayton, VIC, Australia
| | - David F L Liew
- Rheumatology Department, Austin Health, Heidelberg, VIC, Australia; Department of Medicine, University of Melbourne, Parkville, VIC, Australia
| | - Maureen Rischmueller
- Rheumatology Department, Royal Darwin Hospital, Tiwi, NT, Australia; Discipline of Medicine, University of Adelaide, SA, Australia; Rheumatology Department, The Queen Elizabeth Hospital, Woodville, SA, Australia; Rheumatology Department, Alice Springs Hospital, The Gap, NT, Australia
| | - Stephen Brady
- Rheumatology Department, Alice Springs Hospital, The Gap, NT, Australia
| | - Alex Brown
- National Centre for Indigenous Genomics, Australian National University, Canberra, ACT, Australia
| | - Fabien B Vincent
- Centre for Inflammatory Diseases, Monash University, Clayton, VIC, Australia.
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Albitres-Flores L, Perez-Leon S, Bernabe-Ortiz A, Tenorio-Mucha J, Cardenas MK, Vetter B, Safary E, Gamboa R, Cordova V, Gupta R, Moran A, Beran D, Lazo-Porras M. Co-creation process of an intervention to implement a multiparameter point-of-care testing device in a primary healthcare setting for non-communicable diseases in Peru. BMC Health Serv Res 2024; 24:401. [PMID: 38553724 PMCID: PMC10981306 DOI: 10.1186/s12913-024-10809-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 02/29/2024] [Indexed: 04/01/2024] Open
Abstract
BACKGROUND Point-of-care testing (POCT) devices are diagnostic tools that can provide quick and accurate results within minutes, making them suitable for diagnosing non-communicable diseases (NCDs). However, these devices are not widely implemented in healthcare systems and for this reason is relevant to understand the implementation process. AIM To describe the process and define a strategy to implement a multiparameter POCT device for diagnosing and managing NCDs in one region of Peru. METHODS A descriptive and non-experimental study, using the participatory methodologies of co-creation process. It was conducted in one region of Peru (Tumbes) to design an intervention for implementing a multiparameter POCT device. Two co-creation sessions were conducted involving five groups: community members, primary healthcare workers, these groups in both rural and urban settings, and regional decision-makers. These sessions included activities to understand patient journeys in receiving care for NCDs, identify facilitators and barriers to POCT devices usage, and define an implementation strategy for POCT devices in both rural and urban settings of Tumbes. The research team analysed the data and summarized key topics for discussion after each session. RESULTS A total of 78 participants were enrolled across the five groups. Among community members: 22.2% had only diabetes, 24.1% had only hypertension, and 18.5% had both diagnoses. In the patient journey, community members mentioned that it took at least three days to receive a diagnosis and treatment for an NCD. Most of the participants agreed that the POCT devices would be beneficial for their communities, but they also identified some concerns. The strategy for POCT devices implementation included healthcare workers training, POCT devices must be placed in the laboratory area and must be able to perform tests for glucose, glycated haemoglobin, cholesterol, and creatinine. Advertising about POCT devices should be displayed at the healthcare centres and the municipality using billboards and flyers. CONCLUSIONS The co-creation process was useful to develop strategies for the implementation of multiparameter POCT devices for NCDs, involving the participation of different groups of stakeholders guided by moderators in both, rural and urban, settings in Peru.
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Affiliation(s)
- Leonardo Albitres-Flores
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Silvana Perez-Leon
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Antonio Bernabe-Ortiz
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Janeth Tenorio-Mucha
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Maria Kathia Cardenas
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | | | - Ricardo Gamboa
- Global Health Center, Universidad Peruana Cayetano Heredia, Tumbes, Peru
| | | | - Reena Gupta
- Resolve to Save Lives, New York, NY, USA
- Division of General Internal Medicine, San Francisco General Hospital, University of California, San Francisco, USA
| | | | - David Beran
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals & University of Geneva, Geneva, Switzerland
| | - María Lazo-Porras
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru.
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals & University of Geneva, Geneva, Switzerland.
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Russell DJ, Zhao Y, Mathew S, Fitts MS, Johnson R, Reeve DM, Honan B, Niclasen P, Liddle Z, Green D, Wakerman J. The efficiency, timeliness, health outcomes and cost-effectiveness of a new aeromedical retrieval model in Central Australia: A pre- and post-implementation observational study. Aust J Rural Health 2024; 32:17-28. [PMID: 37916478 DOI: 10.1111/ajr.13057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 10/01/2023] [Accepted: 10/15/2023] [Indexed: 11/03/2023] Open
Abstract
OBJECTIVE To assess timeliness, efficiency, health outcomes and cost-effectiveness of the 2018 redesigned Central Australian aeromedical retrieval model. DESIGN Pre- and postimplementation observational study of all patients receiving telehealth consultations from remote medical practitioners (RMPs) or Medical Retrieval and Consultation Centre (MRaCC) physicians between 1/1/2015 and 29/2/2020. Descriptive and inferential statistics measuring system efficiency, timeliness, health outcomes and incremental cost-effectiveness. FINDINGS There were 9%-10% reductions in rates of total aeromedical retrievals, emergency department admissions and hospitalisations postimplementation, all p-values < 0.001. Usage rates for total hospital bed days and ICU hours were 17% lower (both p < 0.001). After adjusting for periodicity (12% fewer retrievals on weekends), each postimplementation year, there were 0.7 fewer retrievals/day (p = 0.002). The mean time from initial consultation to aeromedical departure declined by 18 minutes post-implementation (115 vs. 97 min, p = 0.007). The hazard of death within 365 days was nonsignificant (0.912, 95% CI 0.743-1.120). Postimplementation, it cost $302 more per hospital admission and $3051 more per year of life saved, with a 75% probability of cost-effectiveness. These costs excluded estimated savings of $744,528/year in reduced hospitalisations and the substantial social and out-of-pocket costs to patients and their families associated with temporary relocation to Alice Springs. CONCLUSION Central Australia's new critical care consultant-led aeromedical retrieval model is more efficient, is dispatched faster and is more cost-effective. These findings are highly relevant to other remote regions in Australia and internationally that have comparable GP-led retrieval services.
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Affiliation(s)
- Deborah Jane Russell
- Menzies School of Health Research, Charles Darwin University, Alice Springs, Northern Territory, Australia
| | - Yuejen Zhao
- Northern Territory Department of Health, Health Statistics and Informatics, Darwin, Northern Territory, Australia
| | - Supriya Mathew
- Menzies School of Health Research, Charles Darwin University, Alice Springs, Northern Territory, Australia
| | - Michelle Susannah Fitts
- Menzies School of Health Research, Charles Darwin University, Alice Springs, Northern Territory, Australia
| | - Richard Johnson
- Northern Territory Health, Central Australian Health Service, The Gap, Northern Territory, Australia
| | - David Mark Reeve
- Northern Territory Health, Central Australian Health Service, The Gap, Northern Territory, Australia
| | - Bridget Honan
- Northern Territory Health, Central Australian Health Service, The Gap, Northern Territory, Australia
| | - Petra Niclasen
- Northern Territory Health, Central Australian Health Service, The Gap, Northern Territory, Australia
| | - Zania Liddle
- Menzies School of Health Research, Charles Darwin University, Alice Springs, Northern Territory, Australia
| | - Danielle Green
- Northern Territory Department of Health, Health Statistics and Informatics, Darwin, Northern Territory, Australia
| | - John Wakerman
- Menzies School of Health Research, Charles Darwin University, Alice Springs, Northern Territory, Australia
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Mathew S, Russell DJ, Fitts MS, Wakerman J, Honan B, Johnson R, Zhao Y, Reeve D, Niclasen P. Optimising medical retrieval processes and outcomes in remote areas in high‐income countries: A scoping review. Aust J Rural Health 2022; 30:842-857. [DOI: 10.1111/ajr.12908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 05/16/2022] [Accepted: 06/26/2022] [Indexed: 11/27/2022] Open
Affiliation(s)
- Supriya Mathew
- Menzies School of Health Research Charles Darwin University Alice Springs Northern Territory Australia
| | - Deborah J. Russell
- Menzies School of Health Research Charles Darwin University Alice Springs Northern Territory Australia
| | - Michelle S. Fitts
- Menzies School of Health Research Charles Darwin University Alice Springs Northern Territory Australia
| | - John Wakerman
- Menzies School of Health Research Charles Darwin University Alice Springs Northern Territory Australia
| | - Bridget Honan
- Emergency and Retrieval Consultant, Medical Retrieval and Consultation Centre, Central Australian Retrieval Service Alice Springs Hospital Alice Springs Northwest Territories Australia
| | - Richard Johnson
- Emergency and Retrieval Consultant, Medical Retrieval and Consultation Centre, Central Australian Retrieval Service Alice Springs Hospital Alice Springs Northwest Territories Australia
| | - Yuejen Zhao
- Population and Digital Health, Department of Health Northern Territory Government Darwin Northwest Territories Australia
| | - David Reeve
- Primary and Public Health Care, Central Australia Health Service, Department of Health NTG Alice Springs Northwest Territories Australia
| | - Petra Niclasen
- Central Australian Retrieval Service Alice Springs Hospital Alice Springs Northwest Territories Australia
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Kapur A, Boutin S, Lyster K, Irvine J, Sawchuk K. Retrospective application of the HEAR score on patients evacuated for chest pain: Assessing the utility of point-of-care troponin. CANADIAN JOURNAL OF RURAL MEDICINE 2022; 27:16-21. [PMID: 34975112 DOI: 10.4103/cjrm.cjrm_23_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Introduction The HEART scoring system codifies the clinical gestalt used by physicians with 0-2 points assigned to 5 criteria (history, electrocardiography, age, risk factors and troponin). This scoring provides a prognostic tool that assists in disposition planning. The use of a truncated HEART score, minus the troponin data (HEAR score), was used for patients presenting with chest pain at one of four outpost nursing stations served by La Ronge Health Centre in northern Saskatchewan. These nursing stations have no onsite physician and no ability to obtain any troponin data. This study set out to determine if there was any utility in conducting point-of-care (PoC) troponins in these nursing outposts. Materials and Methods A retrospective analysis was conducted using the La Ronge regional electronic medical record by searching for all patients for whom an outpost nurse had called a physician regarding chest pain symptoms between 01 January 2011 and 31 December 2016. The HEAR and HEART score were then calculated for each individual presentation of patients with chest pain that met inclusion and exclusion criteria. Results By calculating both the patient's HEART score before evacuation from the outposts and after (i.e. with the troponin data), we were able to determine that, in 89.4% of cases (110/123 events), patients would require evacuation regardless of the troponin values due to a HEART score ≥4. In 10.6% (13/124 events) of cases, the patients who were evacuated had a HEART score ≤3, and in only one case did the troponin data increase this score. Conclusions The majority of patients would continue to be evacuated regardless of the result of their PoC troponin due to an already elevated HEAR score. PoC troponin is unlikely to reduce the rate of evacuation of patients with chest pain from the nursing stations served by the La Ronge Health Centre.
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Affiliation(s)
- A Kapur
- Emergency Medicine, University of Saskatchewan, Regina, SK, Canada
| | - S Boutin
- Emergency Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - K Lyster
- Family Medicine, University of Saskatchewan, Regina, SK, Canada
| | - J Irvine
- Internal Medicine, Regina Qu'appelle Health Region, Regina, SK, Canada
| | - K Sawchuk
- Academic Family Medicine, University of Saskatchewan, LaRonge, SK, Canada
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Regan B, O'Kennedy R, Collins D. Advances in point-of-care testing for cardiovascular diseases. Adv Clin Chem 2021; 104:1-70. [PMID: 34462053 DOI: 10.1016/bs.acc.2020.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Point-of-care testing (POCT) is a specific format of diagnostic testing that is conducted without accompanying infrastructure or sophisticated instrumentation. Traditionally, such rapid sample-to-answer assays provide inferior analytical performances to their laboratory counterparts when measuring cardiac biomarkers. Hence, their potentially broad applicability is somewhat bound by their inability to detect clinically relevant concentrations of cardiac troponin (cTn) in the early stages of myocardial injury. However, the continuous refinement of biorecognition elements, the optimization of detection techniques, and the fabrication of tailored fluid handling systems to manage the sensing process has stimulated the production of commercial assays that can support accelerated diagnostic pathways. This review will present the latest commercial POC assays and examine their impact on clinical decision-making. The individual elements that constitute POC assays will be explored, with an emphasis on aspects that contribute to economically feasible and highly sensitive assays. Furthermore, the prospect of POCT imparting a greater influence on early interventions for medium to high-risk individuals and the potential to re-shape the paradigm of cardiovascular risk assessments will be discussed.
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Affiliation(s)
- Brian Regan
- School of Biotechnology, Dublin City University, Dublin, Ireland.
| | - Richard O'Kennedy
- School of Biotechnology, Dublin City University, Dublin, Ireland; Research Complex, Hamad Bin Khalifa University, Qatar Foundation, Doha, Qatar
| | - David Collins
- School of Biotechnology, Dublin City University, Dublin, Ireland
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Randell EW, Thakur V. Leading POCT Networks: Operating POCT Programs Across Multiple Sites Involving Vast Geographical Areas and Rural Communities. EJIFCC 2021; 32:179-189. [PMID: 34421486 PMCID: PMC8343053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/29/2022]
Abstract
Few peer-reviewed publications provide laboratory leaders with useful strategies on which to develop and implement point of care testing (POCT) programs to support delivery of acute care services to remote rural communities, with or without trained laboratory staff on site. This mini review discusses common challenges faced by laboratory leaders poised to implement and operate POCT programs at multiple remote and rural sites. It identifies areas for consideration during the initial program planning phases and provides areas for focus during evaluation and for continued improvement of POCT services at remote locations. Finally, it discusses a potential oversight framework for governance and leadership of multisite POCT programs servicing remote and rural communities.
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Affiliation(s)
- Edward W. Randell
- Laboratory Medicine, Eastern Health Authority, St. John’s, Newfoundland and Labrador, Canada, Faculty of Medicine, Memorial University, St. John’s, Newfoundland and Labrador, Canada,Corresponding author: Prof. Edward W. Randell Lab. Medicine, Eastern Health Authority & Faculty of Medicine, Memorial University Rm 1J442 Laboratory Medicine Eastern Health St. John’s, NL Canada Phone: 709-777-6375 Fax: 709-777-2442 E-mail:
| | - Vinita Thakur
- Laboratory Medicine, Eastern Health Authority, St. John’s, Newfoundland and Labrador, Canada, Faculty of Medicine, Memorial University, St. John’s, Newfoundland and Labrador, Canada
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Lingervelder D, Koffijberg H, Kusters R, IJzerman MJ. Health Economic Evidence of Point-of-Care Testing: A Systematic Review. PHARMACOECONOMICS - OPEN 2021; 5:157-173. [PMID: 33405188 PMCID: PMC8160040 DOI: 10.1007/s41669-020-00248-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/12/2020] [Indexed: 05/05/2023]
Abstract
OBJECTIVE Point-of-care testing (POCT) has become an essential diagnostic technology for optimal patient care. Its implementation, however, still falls behind. This paper reviews the available evidence on the health economic impact of introducing POCT to assess if poor POCT uptake may be related to lacking evidence. STUDY DESIGN The Scopus and PubMed databases were searched to identify publications describing a health economic evaluation of a point-of-care (POC) test. Data were extracted from the included publications, including general and methodological characteristics as well as the study results summarized in either cost, effects or an incremental cost-effectiveness ratio. Results were sorted into six groups according to the POC test's purpose (diagnosis, screening or monitoring) and care setting (primary care or secondary care). The reporting quality of the publications was determined using the CHEERS checklist. RESULTS The initial search resulted in 396 publications, of which 44 met the inclusion criteria. Most of the evaluations were performed in a primary care setting (n = 31; 70.5%) compared with a secondary care setting (n = 13; 29.5%). About two thirds of the evaluations were on POC tests implemented with a diagnostic purpose (n = 28; 63.6%). More than 75% of evaluations concluded that POCT is recommended for implementation, although in some cases only under specific circumstances and conditions. Compliance with the CHEERS checklist items ranged from 20.8% to 100%, with an average reporting quality of 72.0%. CONCLUSION There were very few evaluations in this review that advised against the implementation of POCT. However, the uptake of POCT in many countries remains low. Even though the evaluations included in this review did not always include the full long-term benefits of POCT, it is clear that health economic evidence across a few dimensions of value already indicate the benefits of POCT. This suggests that the lack of evidence on POCT is not the primary barrier to its implementation and that the low uptake of these tests in clinical practice is due to (a combination of) other barriers. In this context, aspects around organization of care, support of clinicians and quality management may be crucial in the widespread implementation of POCT.
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Affiliation(s)
- Deon Lingervelder
- Health Technology and Services Research Department, Technical Medical Centre, University of Twente, P.O. Box 217, Enschede, 7500 AE, The Netherlands
| | - Hendrik Koffijberg
- Health Technology and Services Research Department, Technical Medical Centre, University of Twente, P.O. Box 217, Enschede, 7500 AE, The Netherlands
| | - Ron Kusters
- Health Technology and Services Research Department, Technical Medical Centre, University of Twente, P.O. Box 217, Enschede, 7500 AE, The Netherlands
- Laboratory for Clinical Chemistry and Haematology, Jeroen Bosch Hospital, 's Hertogenbosch, The Netherlands
| | - Maarten J IJzerman
- Health Technology and Services Research Department, Technical Medical Centre, University of Twente, P.O. Box 217, Enschede, 7500 AE, The Netherlands.
- Cancer Health Services Research Unit, School of Population and Global Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia.
- Victorian Comprehensive Cancer Centre, Melbourne, Australia.
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Matthews SJ, Spaeth B, Duckworth L, Richards JN, Prisk E, Auld M, Quirk T, Omond R, Shephard MDS. Sustained Quality and Service Delivery in an Expanding Point-of-Care Testing Network in Remote Australian Primary Health Care. Arch Pathol Lab Med 2020; 144:1381-1391. [PMID: 33106859 DOI: 10.5858/arpa.2020-0107-oa] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2020] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Since 2008, the Northern Territory Point-of-Care Testing Program has improved patient access to pathology testing for acute and chronic disease management for remote health services. OBJECTIVE.— To evaluate the analytical quality, service delivery, and clinical utility of an expanding remote point-of-care testing network. DESIGN.— Four years (2016-2019) of data on analytical quality, test numbers, and training statistics and 6 months of clinical point-of-care testing data from Abbott i-STATs at remote health services throughout the Northern Territory were analyzed to assess analytical performance, program growth, and clinical utility. RESULTS.— From 2016 to 2019, point-of-care test numbers increased, with chemistry and blood gas testing more than doubling to 8500 and 6000 tests, respectively, troponin I testing almost doubling (to 6000), and international normalized ratio testing plateauing at 8000 tests. Participation in quality control and proficiency testing was high, with quality comparable to laboratory-based analytical goals. A shift toward flexible training and communication modes was noted. An audit of point-of-care test results demonstrated elevated creatinine, associated with chronic kidney disease management, as the most common clinically actionable patient result. CONCLUSIONS.— The Northern Territory Point-of-Care Testing Program provides high quality point-of-care testing within remote primary health services for acute and chronic patient management and care. Clinical need, sound analytical performance, flexibility in training provision, and effective support services have facilitated the sustainability of this expanding point-of-care testing model in the remote Northern Territory during the past 11 years.
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Affiliation(s)
- Susan Janet Matthews
- From Flinders University International Centre for Point-of-Care Testing, Flinders University, Adelaide, Australia (Matthews, Spaeth, Duckworth, Richards, Prisk, Shephard)
| | - Brooke Spaeth
- From Flinders University International Centre for Point-of-Care Testing, Flinders University, Adelaide, Australia (Matthews, Spaeth, Duckworth, Richards, Prisk, Shephard)
| | - Lauren Duckworth
- From Flinders University International Centre for Point-of-Care Testing, Flinders University, Adelaide, Australia (Matthews, Spaeth, Duckworth, Richards, Prisk, Shephard)
| | - Janet Noreen Richards
- From Flinders University International Centre for Point-of-Care Testing, Flinders University, Adelaide, Australia (Matthews, Spaeth, Duckworth, Richards, Prisk, Shephard)
| | - Emma Prisk
- From Flinders University International Centre for Point-of-Care Testing, Flinders University, Adelaide, Australia (Matthews, Spaeth, Duckworth, Richards, Prisk, Shephard)
| | - Malcolm Auld
- the Primary Health Care Branch, Central Australian Health Service, Department of Health, Northern Territory Government, Alice Springs, Australia (Auld)
| | - Tina Quirk
- the Safety and Quality Unit (Quirk), Primary Health Care Branch, Top End Health Service, Department of Health, Northern Territory Government, Casuarina, Australia
| | - Rodney Omond
- the Medical Unit (Omond), Primary Health Care Branch, Top End Health Service, Department of Health, Northern Territory Government, Casuarina, Australia
| | - Mark D S Shephard
- From Flinders University International Centre for Point-of-Care Testing, Flinders University, Adelaide, Australia (Matthews, Spaeth, Duckworth, Richards, Prisk, Shephard)
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10
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Shephard M, Shephard A, Matthews S, Andrewartha K. The Benefits and Challenges of Point-of-Care Testing in Rural and Remote Primary Care Settings in Australia. Arch Pathol Lab Med 2020; 144:1372-1380. [PMID: 33106858 DOI: 10.5858/arpa.2020-0105-ra] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2020] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Point-of-care (POC) testing has significant potential application in rural and remote Australian communities where access to laboratory-based pathology testing is often poor and the burden of chronic, acute, and infectious disease is high. OBJECTIVE.— To explore the clinical, operational, cultural, and cost benefits of POC testing in the Australian rural and remote health sector and describe some of the current challenges and limitations of this technology. DATA SOURCES.— Evidence-based research from established POC testing networks for chronic, acute, and infectious disease currently managed by the International Centre for Point-of-Care Testing at Flinders University are used to highlight the experience gained and the lessons learned from these networks and, where possible, describe innovative solutions to address the current barriers to the uptake of POC testing, which include governance, staff turnover, maintaining training and competency, connectivity, quality testing, sustainable funding mechanisms, and accreditation. CONCLUSIONS.— Point-of-care testing can provide practical and inventive opportunities to revolutionize the delivery of pathology services in rural and remote sectors where clinical need for this technology is greatest. However, many barriers to POC testing still exist in these settings, and the full potential of POC testing cannot be realized until these limitations are addressed and resolved.
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Affiliation(s)
- Mark Shephard
- From Flinders University International Centre for Point-of-Care Testing, Flinders University, Adelaide, Australia
| | - Anne Shephard
- From Flinders University International Centre for Point-of-Care Testing, Flinders University, Adelaide, Australia
| | - Susan Matthews
- From Flinders University International Centre for Point-of-Care Testing, Flinders University, Adelaide, Australia
| | - Kelly Andrewartha
- From Flinders University International Centre for Point-of-Care Testing, Flinders University, Adelaide, Australia
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11
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Wong HY, Marcu LG, Bezak E, Parange NA. Review of Health Economics of Point-of-Care Testing Worldwide and Its Efficacy of Implementation in the Primary Health Care Setting in Remote Australia. Risk Manag Healthc Policy 2020; 13:379-386. [PMID: 32440241 PMCID: PMC7212773 DOI: 10.2147/rmhp.s247774] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 04/20/2020] [Indexed: 11/30/2022] Open
Abstract
There are important differences concerning health outcomes between the Australian population living in rural/remote regions and the urban population. Health care provision in remote areas, particularly in regions with a low number of inhabitants, is not without challenges. Aboriginal, rural and remote communities are therefore affected, as they face various obstacles in accessing health services, owing to geographical settings, difficulties in transportation to nearby hospitals, limited or inexistent local qualified personnel. The implementation of point-of-care testing could be a plausible solution to these challenges, as various point-of-care services that have been successfully put into action worldwide indicate towards positive clinical outcomes. Point-of-care units have a real potential in reducing morbidity and mortality in all population groups. This article aims to review the published literature on point-of-care testing around the world, with a focus on health economics and the feasibility of its implementation in Australian rural and remote regions.
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Affiliation(s)
- Hoi Yan Wong
- Division of Health Sciences, University of South Australia, Adelaide, SA 5000, Australia
| | - Loredana G Marcu
- Faculty of Informatics & Science, University of Oradea, Oradea 410087, Romania.,Cancer Research Institute and School of Health Sciences, University of South Australia, Adelaide, SA 5001, Australia
| | - Eva Bezak
- Division of Health Sciences, University of South Australia, Adelaide, SA 5000, Australia.,Cancer Research Institute and School of Health Sciences, University of South Australia, Adelaide, SA 5001, Australia.,Department of Physics, University of Adelaide, Adelaide, SA 5005, Australia
| | - Nayana Anupam Parange
- Division of Health Sciences, University of South Australia, Adelaide, SA 5000, Australia.,Cancer Research Institute and School of Health Sciences, University of South Australia, Adelaide, SA 5001, Australia
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AACC Guidance Document on Management of Point-of-Care Testing. J Appl Lab Med 2020; 5:762-787. [DOI: 10.1093/jalm/jfaa059] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 03/23/2020] [Indexed: 02/01/2023]
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Impact of point-of-care testing for white blood cell count on triage of patients with infection in the remote Northern Territory of Australia. Pathology 2019; 51:512-517. [PMID: 31262564 DOI: 10.1016/j.pathol.2019.04.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 04/02/2019] [Accepted: 04/09/2019] [Indexed: 11/23/2022]
Abstract
In Australia's Northern Territory (NT), acute infections are highly prevalent within Indigenous remote communities and difficulties in diagnosing the aetiology of infection are exacerbated by limited access to diagnostic tests. The objective of this study was to investigate the clinical effectiveness of point-of-care (POC) testing for total and 5-part differential white blood cell (WBC DIFF) counts for the triage of patients with possible acute infection. The HemoCue WBC DIFF POC device was introduced into 13 remote health clinics over a 6 month period. A retrospective clinical audit of patient cases meeting the selection criteria for three acute infections (sepsis, respiratory infection and appendicitis) were examined by four registrars in duplicate; one with POC test results available and the other with POC test results removed to determine if WBC DIFF results changed or assisted in patient triage. The number of changed outcomes provided a preliminary cost-benefit analysis. Sixty (23%) patient cases met the selection criteria for the clinical effectiveness analysis. POC test results changed the triage decision for 24 (41%) patients, of which 20 (34%) led to the prevention of an unnecessary medical retrieval and four (7%) indicated the patient had an acute infection which required a medical retrieval. POC test results assisted decision making for a further 13 (22%) patients. Cost savings related to avoiding unnecessary medical retrievals were estimated to be AU$481,440. Extrapolated NT-wide cost savings are projected to be AU$5.33 million per annum. POC testing for WBC DIFF counts aided clinical decision making for triaging patients with three common acute infections.
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Patel K, Suh-Lailam BB. Implementation of point-of-care testing in a pediatric healthcare setting. Crit Rev Clin Lab Sci 2019; 56:239-246. [PMID: 30973797 DOI: 10.1080/10408363.2019.1590306] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Point-of-care testing (POCT) refers to testing performed outside the clinical laboratory near the patient or at the site of patient care. This could be in critical care settings like the intensive care unit (ICU) and emergency department (ED) or primary care settings like physician offices where testing is performed by nonlaboratory personnel. POCT circumvents several steps in central laboratory testing including specimen transportation and processing resulting in faster turnaround times. Provider access to rapid test results at the site of patient care allows for prompt medical decision making which can lead to improved patient outcomes, operational efficiencies, patient satisfaction, and even cost savings in some cases. In addition to providing results rapidly, POCT devices have small specimen volume requirements compared to central laboratory tests making POCT particularly attractive for pediatric healthcare settings. The availability of published reports on the impact of POCT implementation in pediatric care are helpful resources when evaluating the clinical necessity of POCT prior to implementation. Even though several studies have shown advantages to implementing POCT in different pediatric settings, it is important to note that limitations exist that might limit the utilization of certain POCTs in some pediatric populations. So, it is important that these limitations and the analytical performance of a test are considered while keeping the target patient population in mind. Since POCTs are performed by non-laboratory staff who are not trained laboratory personnel, one challenge with POCT is maintaining regulatory compliance and quality assurance. It is therefore important that regulatory and quality assurance programs be put in place prior to implementing POCT in the pediatric hospital. With advances in POCT technology, most POCT devices have the capability to interface to the laboratory information system (LIS) and electronic medical record (EMR). POCT device interfacing allows for improved compliance to regulatory and quality assurance standards. Maintaining a cost efficient POCT program is becoming increasingly important as hospitals and healthcare systems are undergoing consolidation and harmonization. This includes assessing the clinical and operational benefit of POCT before implementation and inventory management to ensure minimal reagent wastage. This review discusses these different considerations when implementing POCT with a focus on the pediatric healthcare setting.
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Affiliation(s)
- Khushbu Patel
- a Department of Pathology , UT Southwestern Medical Center , Dallas , TX , USA
| | - Brenda B Suh-Lailam
- b Department of Pathology and Laboratory Medicine , Ann and Robert H. Lurie Children's Hospital of Chicago , Chicago , IL , USA.,c Department of Pathology , Northwestern University Feinberg School of Medicine , Chicago , IL , USA
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Bogavac-Stanojević N. Economic Evaluation as a Tool in Emerging Technology Assessment. EJIFCC 2018; 29:196-200. [PMID: 30479603 PMCID: PMC6247126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Medical technologies are part of health technologies and they include medical devices (MD) and in vitro diagnostics (IVD). They have become a vital part of modern healthcare. Framework for introduction of new technology in the healthcare system includes a few steps: analytical and clinical accuracy assessment, clinical utility determination and economic evaluation. In addition, payers are interested whether new technology is adequate for reimbursement. There are fairly enough specific guidelines for implementation of economic methods at the early stage of IVD development. Searching the available literature in this field, this paper discusses the economic evaluations of emerging medical technologies with focus on point of care testing (POCT) and genetic testing. Results of POCT economy studies depend on investigated perspective (payers, policy makers or society), used effectiveness values (utility, effectiveness or consequence estimated as monetary value) and understanding of clinical pathway. There is a need for better understanding of the care pathway, resource utilisation and how they change with the introduction of POCT. Introduction of genetic testing before drug therapy was recommended with the aim to improve treatment benefit and to reduce costs of adverse drug reaction. Clinical utility and cost-effectiveness analyses should be considered for novel genetic testing - guided treatments. Most of the studies considering genetic testing - guided treatments showed that those combinations were cost-saving or cost-effective compared to standard care. For medical tehnology there is no universal guidance for outcomes measurement, cost calculation, performance requirements, use of a certain type of economic studies and economic thresholds.
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Affiliation(s)
- Nataša Bogavac-Stanojević
- Corresponding author: Nataša Bogavac-Stanojević Department of Medical Biochemistry Faculty of Pharmacy POB 146, 11000 Belgrade Serbia Phone: +381 11 3951279 Fax: + 381 11 3972840 E-mail:
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