Point-of-care testing in the Indigenous rural community

This paper describes three health programs - the 'Umoona Kidney Project', the national 'QAAMS' Program for point-of-care HbA1c testing and the 'Point-of-Care in Aboriginal Hands' Program. The common feature these models share is the use of point-of-care technology for the early detection and/or management of chronic diseases (renal disease, diabetes and cardiovascular disease). The primary focus of each program has been the rural and remote Aboriginal Community Controlled Health Service (ACCHS) sector, because these three chronic diseases account for a huge burden of morbidity and mortality in Aboriginal Australians

How to set up and manage a point-of-care testing service

In this paper, various point-of-care testing (POCT) models for early detection and/or management of chronic diseases in rural Aboriginal communities are used to provide practical examples of how to set up and manage a viable and sustainable point-of-care testing (POCT) service, whether it be in a general medical practice (GP) clinic, Aboriginal health service, or hospital service or clinic

Point-of-care testing comes of age in Australia

A wide range of point-of-care tests is available and being used in both hospital and community settings for acute and chronic illnesses. There have been significant improvements in device technology as well as advances in training methods, procedures to monitor analytical quality, and the electronic capture and management of test results from a central location. Various point-of-care tests have been found to be not inferior to laboratory testing for managing chronic conditions in general practice and Aboriginal medical services. Maintaining the analytical quality of devices and ensuring that staff are properly trained are critical elements in sustaining a high quality point-of-care testing service

Point-of-care testing in the Aboriginal community

This article documents experiences working in the field of Aboriginal health. The principle focus of the work is the application of Point-of-Care (POC) technology for the early detection and management of chronic diseases in the Aboriginal community setting. Apart from the well acknowledged advantages of using POC technology such as portability and small sample size, there are other advantages specific, and directly applicable, to the Aboriginal health care setting

Assisting diabetes management through point-of-care HbA1c testing - the QAAMS program for Aboriginal health workers

Diabetes has had a devastating impact on the health of Indigenous people throughout the world. In Australia, Aboriginal and Torres Strait Islander people suffer between 12 and 17 times more deaths due to diabetes than non-Indigenous people. In many Aboriginal communities rates of Type 2 diabetes range from 15% to 30%. Diabetes itself is a significant risk factor for heart disease and is the major cause of end-stage renal disease in Aboriginal people. This article describes a national program called QAAMS (or Quality Assurance for Aboriginal Medical Services) that was developed to assist the management of Aboriginal people with diabetes. Aboriginal Health Workers administer the program on a day-to-day basis. The unique feature of the program is that it uses a point-of-care medical instrument (called the DCA 2000) to measure a test for the long-term control of diabetes (called Haemoglobin A1c)

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, 2.6% for triglyceride, 5.2% for HDL cholesterol and 6.2% for calculated LDL cholesterol on the Cholestech, and 4.4% for total cholesterol, 4.8% for triglyceride, 7.0% for HDL cholesterol and 7.4% for calculated LDL cholesterol on the Cardiochek. In a patient comparison study (n=100), correlation coefficients (r) between the POCT and laboratory methods were greater than 0.90 for all tests for the Cholestech and greater than 0.84 for all tests for the Cardiochek. The mean difference (bias) between the results obtained on the Cholestech LDX and the laboratory method was not statistically significant; however the mean difference between the CardioChek and the laboratory method was statistically significant for total, HDL and LDL cholesterol (one way analysis of variance with Scheffe post-hoc test). The Cholestech LDX met the NCEP goal for total error for all analytes except LDL cholesterol. The CardioChek PA system met the NCEP total error goal for triglyceride but not the other lipid analytes. We conclude that the Cholestech LDX device is a suitable POCT device for cardiovascular risk assessment in the primary care setting, while the Cardiochek device requires more study and refinement

Assessment of the point-of-care Cholestech Lipid Analyser for lipid screening in Aboriginal communities

Cardiovascular disease is the leading cause of mortality in Aboriginal Australians. Screening for cardiovascular disease risk factors, notably elevated blood lipids, is urgently needed. The small portable Cholestech machine (Point-of-Care Diagnostics) can enzymatically measure total cholesterol, triglyceride and HDL cholesterol (without the prior need for precipitation of other lipoproteins)on 35 microlitres of capillary or veinous whole blood in under 5 minutes. It also calculates LDL cholesterol. Its suitability for use in Aboriginal communities was assessed. With its simple operation, fully automated nature, sound analytic performance and ability to produce a full lipid profile in under 5 minutes, the Cholestech would be suitable for the Aboriginal health care setting

Screening for renal disease in a remote Aboriginal community using the Bayer DCA 2000

End-stage renal disease among Aboriginal Australians has reached alarming proportions during the past decade. The early identification of this disease through community screening programs is a key strategy in reducing the long-term financial and cultural burden of the disease. The small point-of-care Bayer DCA 2000 analyser, which tests for urine albumin:creatinine ratio (ACR), was used as a marker for early renal disease in an adult screening program in a remote South Australian Aboriginal community. Nineteen percent of 149 adults screened had previously undiagnosed persistent microalbuminuria (ACR between 3.4 and 33.9 mg/mmol), while a further 9% had persistent overt albuminuria (ACR greater than or equal to 34 mg/mmol). Aboriginal health workers were trained in the operation of the DCA 2000 to enable screening to be an ongoing, sustainable activity within the community setting. The DCA exhibited excellent analytical performance characteristics and was robust and reliable throughout the study period

Measuring change

A change in the reporting of HbA1c is being adopted globally, including in Australia. It's anticipated that this change will, among other things, make it easier for doctors to educate their patients about the importance of glycaemic control. However, to understand how this change will help in practice, it's useful to firstly understand what HbA1c is and to know something of the history of how laboratories have measured the HbA1c assay

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

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. In total, 4968 patients (1958 control and 3010 intervention) participated in the Trial. The point-of-care (PoC) tests performed by intervention practices were: haemoglobin A1c (HbA1c) and urine albumin:creatinine ratio (ACR) on patients with diabetes, total cholesterol, triglyceride and high density lipoprotein (HDL) cholesterol on patients with hyperlipidaemia, and international normalised ratio (INR) on patients on anticoagulant therapy. Three PoCT devices measured these tests: the Siemens DCA 2000 (Siemens HealthCare Diagnostics, Melbourne, VIC, Australia) for HbA1c and urine ACR; Point of Care Diagnostics Cholestech LDX analyser (Point of Care Diagnostics; Sydney, NSW, Australia) for lipids; and the Roche CoaguChek S (Roche Diagnostics; Sydney, NSW, Australia) for INR. Point-of-care testing in the General Practice Trial was underpinned by a quality management framework which included an on-going training and competency program for PoCT device operators. This article describes the design, implementation and results of the training and competency program